Summary
An emerging infectious disease was identified as severe fever with thrombocytopenia syndrome (SFTS) in central China since late March 2009. We found the patients with SFTS had severe clinical symptoms, and progressed rapidly to multiple organ dysfunction syndrome (MODS) with high fatality rate of 25%–30%. The aim of this study was to assess the significance of risk factors predicting the development of MODS and death in SFTS patients. Consecutive SFTS admissions between May 2009 and September 2011 were analyzed for parameters of organ function during hospitalization using Marshall scoring system for MODS, and platelet counts were recorded on admission and at 24, 48, 72 h and one week after admission. We investigated the kinetics of organ failures and analyzed the association between age, platelet count and development of MODS or death. A total of 92 SFTS patients were enrolled in this study. Among them, 32 patients with dysfunction of over 4 organs were identified, 45% of them died within 72 h, 72% died within 5 days, and 76% died within 7 days after admission. We also found cumulative Marshall score was significantly higher in death patients (11.76±2.05) than in survival patients (4.22±1.98) (P<0.001). In addition, SFTS patients had older age and lower platelet counts in MODS and death groups. Furthermore, we also observed that there was a close correlation between platelet count on admission and Marshall score (P<0.001). High Marshall score, advanced age and lower platelet counts were the main risk factors for the development of MODS, and those factors could predict mortality in SFTS patients, suggesting prompt treatment and close monitoring of severe complications, especially MODS, are of great importance in saving patients’ lives.
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References
Feldmann H. Truly emerging—a new disease caused by a novel virus. N Engl J Med, 2011,364(16):1561–1563
Zhang L, Liu Y, Ni D, et al. Nosocomial transmission of human granulocytic anaplasmosis in China. JAMA, 2008,300(19):2263–2270
Dhand A, Nadelman RB, Aguero-Rosenfeld M, et al. Human granulocytic anaplasmosis during pregnancy: case series and literature review. Clin J Infect Dis, 2007,45(5):589–593
Bakken JS, Krueth JK, Lund T, et al. Exposure to deer blood may be a cause of human granulocytic ehrlichiosis. Clin Infect Dis, 1996,23:198
Gai Z, Liang M, Zhang S, et al. Person-to-person transmission of severe fever with thrombocytopenia syndrome bunyavirus through blood contact. Clin Infect Dis, 2012,54(2):249–252
Dumler JS, Choi KS, Garcia-Garcia JC, et al. Human granulocytic anaplasmosis and anaplasma phagocytophilum. Emerg Infect Dis, 2005,11(12):1828–1834
Peters CJ, Simpson GL, Levy H. Spectrum of hantavirus infection: hemorrhagic fever with renal syndrome and hantavirus pulmonary syndrome. Annu Rev Med, 1999,50:531–545
Levett PN. Leptospirosis. Clin Microbiol Rev, 2001,14(2): 296–326
Yu XJ, Liang MF, Zhang SY, et al. Fever with thrombocytopenia associated with a novel bunyavirus in China. N Engl J Med, 2011,364(16):1523–1532
Zhang YZ, He YW, Dai YA, et al. Hemorrhagic fever caused by a novel bunyavirus in China: pathogenesis and correlates of fatal outcome. Clin Infect Dis, 2012,54(4): 527–533
Marshall JC, Cook DJ, Christou NV, et al. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med, 1995,23(10):1638–1652
Pepin M, Bouloy M, Bird BH, et al. Rift Valley fever virus (Bunyaviridae: Phlebovirus): an update on pathogenesis, molecular epidemiology, vectors, diagnostics and prevention. Vet Res, 2010,41(6):61
Ergonul O. Crimean-Congo haemorrhagic fever. Lancet Infect Dis, 2006,6(4):203–214
Vinh DC, Embil JM. Hantavirus pulmonary syndrome: a concise clinical review. South Med J, 2009,102(6): 620–625
Mackow ER, Gavrilovskaya IN. Hantavirus regulation of endothelial cell functions. Thromb Haemost, 2009,102(6): 1030–1041
Gai ZT, Zhang Y, Liang MF, et al. Clinical progress and risk factors for death in severe fever with thrombocytopenia syndrome patients. J Infect Dis, 2012,206(7): 1095–1102
Sidwell RW, Smee DF. Viruses of the Bunya- and Togaviridae families: potential as bioterrorism agents and means of control. Antiviral Res, 2003,57(1–2):101–111
Mardani M, Jahromi MK, Naieni KH, et al. The efficacy of oral ribavirin in the treatment of crimean-congo hemorrhagic fever in Iran. Clin Infect Dis, 2003,36(12): 1613–1618
Huggins JW, Hsiang CM, Cosgriff TM, et al. Prospective, double-blind, concurrent, placebo-controlled clinical trial of intravenous ribavirin therapy of hemorrhagic fever with renal syndrome. J Infect Dis, 1991,164(6):1119–1127
Zhang YZ, Zhou DJ, Xiong YW, et al. Hemorrhagic fever caused by a novel tick-borne Bunyavirus in Huaiyangshan, China. Chin J Epidemiol, 2011,32(3):209–220
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These authors contributed equally to this work.
This project was supported by the National Natural Science Foundation of China (No. 81171638).
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Jie, Sh., Zhou, Y., Sun, Lp. et al. Close correlation between development of MODS during the initial 72 h of hospitalization and hospital mortality in severe fever with thrombocytopenia syndrome. J. Huazhong Univ. Sci. Technol. [Med. Sci.] 33, 81–85 (2013). https://doi.org/10.1007/s11596-013-1075-1
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DOI: https://doi.org/10.1007/s11596-013-1075-1