Clinical features and factors associated with severity and fatality among patients with severe fever with thrombocytopenia syndrome Bunyavirus infection in Northeast China.
Clinical features and factors associated with severity and fatality among patients with severe fever with thrombocytopenia syndrome Bunyavirus infection in Northeast China.
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DOI：
10.1371/journal.pone.0080802
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Liu P
中科院分区：
文献类型：
--
作者：
Deng B;Zhou B;Zhang S;Zhu Y;Han L;Geng Y;Jin Z;Liu H;Wang D;Zhao Y;Wen Y;Cui W;Zhou Y;Gu Q;Sun C;Lu X;Wang W;Wang Y;Li C;Wang Y;Yao W;Liu P
2009年，中国发现发热伴血小板减少综合征病毒（SFTSV）是布尼亚病毒科白蛉病毒属的一个新成员。SFTSV感染病例的详细临床特征尚未得到很好的描述，患者严重程度和重症患者病死率的危险因素仍有待确定。回顾性分析2010年6月至2011年12月东北地区收治的115例SFTSV感染住院患者的临床和实验室特征。我们通过多变量分析评估了与确诊病例严重程度和重症病例病死率相关的危险因素。115例患者中有103例（89.6%）出现多器官功能障碍，22例（19.1%）进入危及生命的多器官功能衰竭阶段。在115例患者中，有14例死亡（12.2%）。多因素分析显示，严重程度风险的独立预测因子为：白蛋白≤30 g/l (OR, 8.09; 95% CI, 2.58-25.32)， APTT≥66秒（OR, 14.28; 95% CI, 3.28-62.24），钠≤130 mmol/l (OR, 5.44; 95% CI, 1.38-21.40)，以及是否存在神经症状（OR, 7.70; 95% CI, 1.91-31.12）。在重症患者中，急性肺损伤/急性呼吸窘迫综合征（HR, 4.59; 95% CI, 1.48-14.19）和弥散性血管内凝血（HR, 4.24; 95% CI, 1.38-13.03）与病死率独立相关。SFTSV感染可能呈现比迄今报道更严重的症状和实验室异常。由于感染了一种新型布尼亚病毒，患者可能出现多器官功能障碍，并死于多器官功能衰竭。在对任何SFTS病例的临床评估中，临床医生都需要考虑与预后相关的独立因素。
In 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. Clinical 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. SFTSV 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.
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