PLoS Neglected Tropical Diseases (Nov 2019)

A nomogram to predict mortality in patients with severe fever with thrombocytopenia syndrome at the early stage-A multicenter study in China.

  • Lin Wang,
  • Gang Wan,
  • Yi Shen,
  • Zhenghua Zhao,
  • Ling Lin,
  • Wei Zhang,
  • Rui Song,
  • Di Tian,
  • Jing Wen,
  • Yongxiang Zhao,
  • Xiaoli Yu,
  • Li Liu,
  • Yang Feng,
  • Yuanni Liu,
  • Chunqian Qiang,
  • Jianping Duan,
  • Yanli Ma,
  • Ying Liu,
  • Yanan Liu,
  • Chong Chen,
  • Ziruo Ge,
  • Xingwang Li,
  • Zhihai Chen,
  • Tianli Fan,
  • Wei Li

DOI
https://doi.org/10.1371/journal.pntd.0007829
Journal volume & issue
Vol. 13, no. 11
p. e0007829

Abstract

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BackgroundSevere fever with thrombocytopenia syndrome (SFTS) caused by the SFTS virus is an emerging infectious disease that was first identified in the rural areas of China in 2011. Severe cases often result in death due to multiple organ failure. To date, there are still numerous problems remain unresolved in SFTS, including unclear pathogenesis, lack of specific treatment, and no effective vaccines available.AimTo analyze the clinical information of patients with early-stage SFTS and to establish a nomogram for the mortality risk.MethodsBetween April 2011 and December 2018, data on consecutive patients who were diagnosed with SFTS were prospectively collected from five medical centers distributed in central and northeastern China. Multivariable Cox analyses were used to identify the factors independently associated with mortality. A nomogram for mortality was established using those factors.ResultsDuring the study period, 429 consecutive patients were diagnosed with SFTS at the early stage of the disease (within 7 days of fever), among whom 69 (16.1%) died within 28 days. The multivariable Cox proportional hazard regression analysis showed that low lymphocyte percentage, early-stage encephalopathy, and elevated concentration of serum LDH and BUN were independent risk factors for fatal outcomes. Received-operating characteristic curves for 7-, 14-, and 28-days survival had AUCs of 0.944 (95% CI: 0.920-0.968), 0.924 (95% CI: 0.896-0.953), and 0.924 (95% CI: 0.895-0.952), respectively. Among low-risk patients, 6 patients died (2.2%). Among moderate-risk patients, 25 patients died (24.0%, hazard ratio (HR) = 11.957). Among high-risk patients, the mortality rate was 69.1% (HR = 57.768).ConclusionWe established a simple and practical clinical scoring system, through which we can identify critically ill patients and provide intensive medical intervention for patients as soon as possible to reduce mortality.