Preexisting chronic conditions for fatal outcome among SFTS patients: An observational Cohort Study

Abstract

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that is caused by a novel bunyavirus SFTSV. Currently our knowledge of the host-related factors that influence the pathogenesis of disease is inadequate to allow prediction of fatal outcome. Here we conducted a prospective study of the largest database on the SFTS patients, to identify the presence of comorbidities in SFTS, and estimate their effect on the fatal outcome. Among 2096 patients eligible for inclusion, we identified nine kinds of comorbidities, from which hyperlipidemia (12.2%; 95% CI: 10.8%–13.6%), hypertension (11.0%; 95% CI: 9.6%–12.3%), chronic viral hepatitis (CVH) (9.3%; 95% CI: 8.1%–10.5%), and diabetes mellitus (DM) (6.8%; 95% CI: 5.7%–7.9%) were prevalent. Higher risk of death was found in patients with DM (adjusted OR = 2.304; 95% CI: 1.520–3.492; P<0.001), CVH (adjusted OR = 1.551; 95% CI: 1.053–2.285; P = 0.026) and chronic obstructive pulmonary diseases (COPD) (adjusted OR = 2.170; 95% CI: 1.215–3.872; P = 0.009) after adjusting for age, sex, delay from disease onset to admission and treatment regimens. When analyzing the comorbidities separately, we found that the high serum glucose could augment diseases severity. Compared to the group with max glucose < 7.0 mmol/L, patients with glucose between 7.0–11.1 mmol/L and glucose ≥11.1 mmol/L conferred higher death risk, with the adjusted OR to be 1.467 (95% CI: 1.081–1.989; P = 0.014) and 3.443 (95% CI: 2.427–4.884; P<0.001). Insulin therapy could effectively reduce the risk of severe outcome in DM patients with the adjusted OR 0.146 (95% CI: 0.058–0.365; P<0.001). For CVH patients, severe damage of liver and prolongation of blood coagulation time, as well as high prevalence of bleeding phenotype were observed. These data supported the provocative hypothesis that treating SFTS related complications can attain potentially beneficial effects on SFTS.

Corticosteroids May Have Negative Effects on the Management of Patients with Severe Fever with Thrombocytopenia Syndrome: A Case–Control Study

“…SFTSV infection has been one of the most important public health issues in endemic areas because of its high case fatality ratio, which was reported to be 10–20% in China and South Korea [ 2 , 3 ] and 27–31% in Japan [ 4 , 5 ]. The poor prognostic backgrounds for SFTS include advanced age, male sex [ 6 ], and underlying diseases, such as malignancies, diabetes mellitus, chronic viral hepatitis, and chronic obstructive pulmonary disease [ 5 , 7 ]. In addition, patients with central nervous system manifestations [ 4 , 8 ], high levels of alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and creatine kinase (CK) [ 8 ], renal dysfunction [ 9 ], coagulopathy, high level viremia, and hypercytokinemia were reported to show poor prognosis [ 10 ].…”

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

“…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.…”

Clinical manifestations of death with severe fever and thrombocytopenia syndrome: A meta‐analysis and systematic review

“…This finding is consistent with that of Zhang who insisted underlying disease increases the risk of death (OR = 1.631; p < .001). 8 In Zhang's study, chronic viral hepatitis also increased the risk of death (OR = 2.006; p = .007). It is not uncommon for chronic viral hepatitis to be combined with other viral infections, 9 but there have been few reports of chronic viral hepatitis co‐infection with SFTSV.…”