Impact of glycemia and insulin treatment in fatal outcome of severe fever with thrombocytopenia syndrome

Ge, Honghan; Zhao, Jing; Zhang, Shuai; Xu, Yanli; Liu, Yuanni; Peng, Xue-Fang; Wang, Gang; Gong, Xiao-Yi; Zhang, Ligang; Li, Shuang; Li, Hao; Zhang, Xiao-Ai; Cui, Ning; Yuan, Chun; Li, Gang; Liu, Wei

doi:10.1016/j.ijid.2022.03.038

Cited by 8 publications

(5 citation statements)

References 34 publications

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“…The case-fatality rate in our cohort was 14.7%, which is approximately consistent with previously reported rates in other regions of China [ 34 , 35 ]. We found that patients with SFTS who died were older and had a higher incidence of hemorrhage, encephalitis, and kidney damage, which is consistent with a previous multicenter observational study [ 11 ].…”

Section: Discussionsupporting

confidence: 92%

A High Viral Load in Urine Correlates With Acute Kidney Injury and Poor Outcomes in Hospitalized Patients With Severe Fever With Thrombocytopenia Syndrome: A Noninvasive and Convenient Prognostic Marker

Zhang

Zhao

Dai

et al. 2023

Open Forum Infectious Diseases

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Background Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with an extensive geographical distribution and high mortality rate. To date, the role of SFTS virus (SFTSV) in urine is still elusive. We aimed to explore the relationship between urinary bunyavirus and acute kidney injury (AKI) and mortality in patients with SFTS. Methods Urine samples were collected from 102 patients to quantify SFTSV load in urine (U-SFTSV). Patient renal function was evaluated on admission. Receiver operating characteristic (ROC) curve (AUC) and logistic regression analysis were performed to evaluate the predictive value of U-SFTSV. Viral infectivity assays in Vero cells were performed from 10 urine samples. Results The U-SFTSV level was positively correlated with SFTSV load in plasma (r=0.624) and indicators of renal damage. The U-SFTSV level was identified as an independent risk factor for SFTS-associated AKI (odds ratio, 3.631; 95% confidence interval 1.239-10.640; P=0.019). The U-SFTSV showed great value in predicting the fatal outcome of SFTS patients with high AUC (0.881). The Kaplan‒Meier survival comparison showed that patients with U-SFTSV levels greater than 6379 copies/ml were at a higher risk of death within 28 days after onset. In addition, four urine samples with high U-SFTSV levels were infectious. Conclusions Our large cohort study identified that the U-SFTSV level is a novel convenient and noninvasive predictive biomarker for incidence of AKI and poor outcome of patients with SFTS. Urine specimens could be a source of SFTSV infection in humans.

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Section: Discussionsupporting

confidence: 92%

A High Viral Load in Urine Correlates With Acute Kidney Injury and Poor Outcomes in Hospitalized Patients With Severe Fever With Thrombocytopenia Syndrome: A Noninvasive and Convenient Prognostic Marker

Zhang

Zhao

Dai

et al. 2023

Open Forum Infectious Diseases

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“…All these indicators represented the pathogenic characteristics of cellular immunosuppression, humoral immune regulation disorders, severe neutropenia, and multiple organ dysfunction syndrome, 20,21 which collectively contributed to the increased susceptibility to HAIs in SFTSV infection. The effect of acute hyperglycemia had been previously related to the increased clinical complications and even death by our group, 22 which might be partly mediated by an increased incidence of secondary infection according to the current data.…”

Section: Discussionsupporting

confidence: 70%

Coinfections in hospitalized patients with severe fever with thrombocytopenia syndrome: A retrospective study

Wang

Guo³

et al. 2022

Journal of Medical Virology

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Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne disease with a high case fatality rate. Few studies have been performed on bacterial or fungal coinfections or the effect of antibiotic therapy. A retrospective, observational study was performed to assess the prevalence of bacterial and fungal coinfections in patients hospitalized for SFTSV infection. The most commonly involved microorganisms and the effect of antimicrobial therapy were determined by the site and source of infection. A total of 1201 patients hospitalized with SFTSV infection were included; 359 (29.9%) had microbiologically confirmed infections, comprised of 292 with community-acquired infections (CAIs) and 67 with healthcare-associated infections (HAIs). Death was independently associated with HAIs, with a more significant effect than that observed for CAIs. For bacterial infections, only those acquired in hospitals were associated with fatal outcomes, while fungal infection, whether acquired in hospital or community, was related to an increased risk of fatal outcomes. The infections in the respiratory tract and bloodstream were associated with a higher risk of death than that in the urinary tract. Both antibiotic and antifungal treatments were associated with improved survival for CAIs, while for HAIs, only antibiotic therapy was related to improved survival, and no effect from antifungal therapy was observed. Early administration of

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“…In their cohort study of 77 cases of SFTS, Zhang et al [12] concluded that the detection of blood glucose levels can help in assessing the hypercoagulability and inflammatory status of these patients subjects. A multicenter SFTS cohort study [11] indicated that acute hyperglycemia after admission was a strong predictor of in-hospital death in female patients with SFTS. However, these two clinical studies on SFTS and blood glucose levels included individuals with preexisting diabetes and newly diagnosed diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…Few clinical studies have reported the influence of hyperglycemia on survival outcomes at admission in SFTS. Only two retrospective studies [11,12] have demonstrated the association of hyperglycemia with increased 28-day mortality; however, both partially included individuals with SFTS and preexisting diabetes. Moreover, whether SFTS virus (SFTSV) influences glucose metabolism in individuals without preexisting diabetes, which further causes secondary infection or even exacerbates the condition, remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Effect of fasting plasma glucose level in severe fever and thrombocytopenia syndrome patients without diabetes

Pan,

Yang,

et al. 2024

PLoS Negl Trop Dis

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Hyperglycemia is correlated with worse in-hospital outcomes in acute infectious diseases such as coronavirus disease 2019 (COVID-19) and severe fever with thrombocytopenia syndrome (SFTS). This study assessed the relationship between fasting plasma glucose (FPG) levels and in-hospital mortality, disease type, and secondary infections among individuals with SFTS without preexisting diabetes. The clinical data and laboratory results upon admission of 560 patients with SFTS without preexisting diabetes meeting the inclusion criteria at Wuhan Union Hospital were collected. FPG levels in surviving patients with SFTS subjects were significantly lower than those in patients with SFTS who had died (P<0.0001). In multivariate Cox regression, high FPG level (≥11.1 mmol/L) was a risk factor independently associated with the in-hospital death of patients with SFTS without preexisting diabetes. Similarly, the FPG levels in general patients with SFTS were significantly lower than those in patients with severe SFTS (P<0.0001). Multivariate logistic regression identified high FPG level (7.0–11.1 mmol/L) as a risk factor independently associated with SFTS severity. While FPG levels were comparable between patients with SFTS with and without secondary infection (P = 0.5521), logistic regression analysis revealed that high FPG levels were not a risk factor for secondary infection in patients with SFTS without preexisting diabetes. High FPG level on admission was an independent predictor of in-hospital death and severe disease in individuals with SFTS without preexisting diabetes. FPG screening upon admission and glycemic control are effective methods for improving the prognosis of patients with SFTS.

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Impact of glycemia and insulin treatment in fatal outcome of severe fever with thrombocytopenia syndrome

Cited by 8 publications

References 34 publications

A High Viral Load in Urine Correlates With Acute Kidney Injury and Poor Outcomes in Hospitalized Patients With Severe Fever With Thrombocytopenia Syndrome: A Noninvasive and Convenient Prognostic Marker

A High Viral Load in Urine Correlates With Acute Kidney Injury and Poor Outcomes in Hospitalized Patients With Severe Fever With Thrombocytopenia Syndrome: A Noninvasive and Convenient Prognostic Marker

Coinfections in hospitalized patients with severe fever with thrombocytopenia syndrome: A retrospective study

Effect of fasting plasma glucose level in severe fever and thrombocytopenia syndrome patients without diabetes

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