Clinical Features and Factors Associated with Severity and Fatality among Patients with Severe Fever with Thrombocytopenia Syndrome Bunyavirus Infection in Northeast China

Abstract

BackgroundIn 2009, severe fever with thrombocytopenia syndrome virus (SFTSV) was identified as a novel member of the genus phlebovirus in the Bunyaviridae family in China. The detailed clinical features of cases with SFTSV infection have not been well described, and the risk factors for severity among patients and fatality among severe patients remain to be determined.Methodology/Principal FindingsClinical and laboratory features of 115 hospitalized patients with SFTSV infection during the period from June 2010 to December 2011 in Northeast China were retrospectively reviewed. We assessed the risk factors associated with severity in confirmed cases and fatality in severe cases by multivariate analysis. One hundred and three (89.6%) of 115 patients presented with multiple organ dysfunction, and 22 (19.1%) of 115 proceeded to the stage of life threatening multiple organ failure. Of the 115 patients, 14 fatalities (12.2%) were reported. Multivariate analysis demonstrated that the independent predictors of risk for severity were: albumin ≤30 g/l (OR, 8.09; 95% CI, 2.58-25.32), APTT ≥ 66 seconds (OR, 14.28; 95% CI, 3.28-62.24), sodium ≤130 mmol/l (OR, 5.44; 95% CI, 1.38-21.40), and presence of neurological manifestations (OR, 7.70; 95% CI, 1.91-31.12). Among patients with severe disease, presence of acute lung injury/acute respiratory distress syndrome (HR, 4.59; 95% CI, 1.48–14.19) and disseminated intravascular coagulation (HR, 4.24; 95% CI, 1.38–13.03) were independently associated with fatality.Conclusions/SignificanceSFTSV infection may present with more severe symptoms and laboratory abnormalities than hitherto reported. Due to infection with a novel bunyavirus, the patients may sufferer multiple organ dysfunction and die of multiple organ failure. In the clinical assessment of any case of SFTS, independent factors relating to prognosis need to be taken into account by clinicians.

A Case of Severe Fever With Thrombocytopenia Syndrome Accompanied by Self-Limiting Severe Proteinuria That Inversely Correlated With the Platelet Count

“…Li et al also reported that the PLT counts between both cases were very similar [9]. On the other hand, a study in northeast China showed that the lowest PLT count on admission or throughout hospitalization was associated with the severity of SFTS [11]. In the present case, his PLT count decreased to the lowest value of 41,000/μL on the eighth day, and, thus, he did not need a PLT transfusion.…”

Fatal Severe Fever with Thrombocytopenia Syndrome: An Autopsy Case Report

“…The liver plays a central role in the pathogenesis of SFTSV infection (1, 3). An elevation in liver markers (AST, ALT, and LDH) was observed in five of six cases as found in a majority of SFTS patients (8), and abnormalities were observed in the laboratory tests in four of six cases (including the present case) with regards to coagulopathy, prothrombin time, activated partial thromboplastin time, fibrin/fibrinogen degradation products, fibrinogen, and/or D-dimer, all of which could reflect underlying disseminated intravascular coagulation (DIC). In four of five cases, including the present case, for which a bone marrow examination was performed, hemophagocytosis was observed, and the serum ferritin level was elevated.…”

A Newly Established Severity Scoring System in Predicting the Prognosis of Patients with Severe Fever with Thrombocytopenia Syndrome

“…By the end of 2012, 11 provinces in China have reported SFTS cases (Liu et al 2014). From 2011 to 2012, 2,047 cases were reported, among which 129 died with an average case-fatality ratio of 7.3% (Deng et al 2013). The condition of patients with critical SFTS may proceed quickly and end in multi-organ failure and death.…”