Analysis of clinical features and early warning indicators of death from severe fever with thrombocytopenia syndrome

Xu, Xiaowen; Sun, Zhenlu; Liu, Jingyu; Zhang, Jianjun; Liu, Tao; Mu, Xiaodong; Jiang, Mei

doi:10.1016/j.ijid.2018.05.013

Cited by 42 publications

(35 citation statements)

References 16 publications

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“…Other viral infections associated with hyponatremia include human herpesvirus-6 (HHV-6), SFTS virus (SFTSV), hantavirus, herpes simplex virus (HSV), and Ebola virus infections [ 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”

Section: Hyponatremia Due To Infectionsmentioning

confidence: 99%

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Hyponatremia in Infectious Diseases—A Literature Review

Królicka

Kruczkowska

Krajewska

et al. 2020

IJERPH

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Hyponatremia is one of the most common water–electrolyte imbalances in the human organism. A serum sodium concentration threshold of less than 135 mmol/L is diagnostic for hyponatremia. The disorder is usually secondary to various diseases, including infections. Our review aims to summarize the diagnostic value and impact of hyponatremia on the prognosis, length of the hospitalization, and mortality among patients with active infection. The scientific literature regarding hyponatremia was reviewed using PubMed, ClinicalKey, and Web of Science databases. Studies published between 2011 and 2020 were screened and eligible studies were selected according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and specific inclusion criteria. The most common infections that were associated with hyponatremia were viral and bacterial infections, including COVID-19 (coronavirus disease 2019). The etiology varied according to the infection site, setting and patient cohort it concerned. In several studies, hyponatremia was associated with prolonged hospitalization, worse outcomes, and higher mortality rates. Hyponatremia can also play a diagnostic role in differentiating pathogens that cause a certain infection type, as it was observed in community-acquired pneumonia. Although many mechanisms leading to hyponatremia have already been described, it is impossible with any certainty to ascribe the etiology of hyponatremia to any of them.

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Section: Hyponatremia Due To Infectionsmentioning

confidence: 99%

“…Severe fever with thrombocytopenia syndrome (SFTS) is an infectious disease caused by the SFTSV. Retrospectively, SFTSV infections are uncommon but are associated with high mortality, reported at the level of 33% [ 34 ]. Hyponatremia was found to be an independent risk factor of death in SFTS patients.…”

Section: Hyponatremia Due To Infectionsmentioning

confidence: 99%

Hyponatremia in Infectious Diseases—A Literature Review

Królicka

Kruczkowska

Krajewska

et al. 2020

IJERPH

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“…Preexisting chronic comorbidity is also an attribute that should be considered, since a large part of SFTS patients were the elderly and frequently afflicted by various underlying conditions which conferred an increased risk of adverse outcomes following infection. Previous studies revealed that adverse outcomes of SFTS patients were associated with comorbidities (Deng et al, 2013;Xu et al, 2018;Zhang et al, 2019), which were specifically identified to be diabetes mellitus (DM), chronic virus hepatitis (CVH), and 1 https://is.kdca.go.kr 2 https://www.niid.go.jp chronic obstructive pulmonary diseases (COPD) in one study (Zhang et al, 2019). Up to now, no studies in analyzing the risk of SFTS mortality have ever tried to disentangle the effect from age, sex, or comorbidity.…”

Section: Introductionmentioning

confidence: 99%

Sex Differences in Case Fatality Rate of Patients With Severe Fever With Thrombocytopenia Syndrome

Zhao

et al. 2021

Front. Microbiol.

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Background: Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne disease with high mortality. However, detailed analysis is lacking to explore the complex effect of sex with age or comorbidities.Methods: A retrospective cohort study was performed among 2,938 SFTS patients entered during 2011–2020 in Xinyang, China. The case fatality rate (CFR) was estimated for their association with sex, age, and comorbidities by an interactive way. The difference of immune response between sex was explored in an age dependent way.Results: An overall CFR of 15.3% (450/2,938) was obtained, which appeared to be higher in males than in females [17.7% vs. 13.6%, adjusted odds ratio (aOR) = 1.24; 95% CI, 1.00–1.53; P = 0.048] and increased dramatically with age (P < 0.001). The associations between sex and SFTS fatal outcome were age-dependent and varied according to the status of comorbidities. The mortality-related risk conferred by older age was more pronounced in males, with aOR (95% CI) to be 5.76 (3.75–8.84) vs. 5.30 (3.54–7.95) in female. Sex-stratified analysis disclosed significant associations between death and comorbidities among female patients (aOR = 1.87, 95% CI: 1.40–2.49; P < 0.001), while none among males. Among females, the significant associations between presence of comorbidity and fatal outcome differed among age groups, with aOR (95% CI) decreased from 2.28 (1.16–4.46) in ≤60 years, to 2.06 (1.34–3.18) in 60–70 years and further to 1.55 (0.97–2.47) in >70 years. Altogether 194 SFTS patients were randomly selected for the test of B cells, natural killer (NK) cells, CD4 cells percentages, and anti-SFTSV IgM antibody level, the results revealed that males >60 years had significantly decreased percentages of B cells, CD4 cells, lower anti-SFTSV IgM antibody titer, and increased level of NK cells than male aged ≤60 years, while none of these age specific differences was observed in the females. This finding underlies the more pronounced age specific difference in CFR among male than female.Conclusions: Males had a significantly higher mortality of SFTS than did females, and more likely to be affected by aging for SFTS mortality. This difference can be explained by the effect from comorbidities and the host immunity. It is essential to take a sex- and age-based approach to SFTS treatment and management.

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“…Central nervous system disorders, multiple organ failure, elevated serum AST/ALT/LDH/CK levels, high viral loads, and hemorrhagic symptoms have been reported as factors associated with fatal SFTS . Previous reports have described gastrointestinal, pulmonary, and gingival hemorrhages and subcutaneous petechiae but not intracranial hemorrhage . Only 3 cases of SFTS with intracranial hemorrhage have been identified, all of which were fatal.…”

Section: Discussionmentioning

confidence: 99%

Severe fever with thrombocytopenia syndrome complicated with subdural hematoma: A rare case and literature review

Endo¹,

Yamamoto²,

Inoue

et al. 2019

J of Gen and Family Med

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A 79‐year‐old woman presented with fever and general malaise. Examination revealed hepatic injury, thrombocytopenia, skin lesions, and regional lymphadenopathy; severe fever with thrombocytopenia syndrome (SFTS) was diagnosed using polymerase chain reaction. The patient developed impaired consciousness that worsened after 4 days. Magnetic resonance imaging of the head revealed a subdural hematoma in the occipital region with an uncertain onset time. As SFTS rarely causes intracranial hemorrhage, the associated risk factors are unknown. Clinicians may overlook potential intracranial hemorrhage in stuporous SFTS patients.

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Analysis of clinical features and early warning indicators of death from severe fever with thrombocytopenia syndrome

Abstract: Neurological signs, hemorrhagic manifestations, disturbance of consciousness, hyponatremia, prolonged APTT, and increased CRP and serum creatinine are risk factors for death in SFTS.

Cited by 42 publications

References 16 publications

Hyponatremia in Infectious Diseases—A Literature Review

Hyponatremia in Infectious Diseases—A Literature Review

Sex Differences in Case Fatality Rate of Patients With Severe Fever With Thrombocytopenia Syndrome

Severe fever with thrombocytopenia syndrome complicated with subdural hematoma: A rare case and literature review

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