Severe fever with thrombocytopenia syndrome (SFTS), caused by the SFTS virus (SFTSV), poses a significant global health challenge due to its high mortality rates and absence of specific treatments or vaccines. First identified in China in 2009 and subsequently reported in Korea and Japan, SFTS has spread across Asia, highlighting its potential to become a worldwide public health concern.
Read full Article: Increased cTnI Predicts Early Death in Patients with Severe Fever with Thrombocytopenia: A Multicenter Study in North China
The disease manifests with severe symptoms including acute fever, gastrointestinal problems, hemorrhagic manifestations, and neurological complications. Mortality rates among hospitalized patients range alarmingly from 12% to 50%, underscoring the urgent need for effective prognostic tools and targeted therapies.
Recent studies have identified multiorgan involvement in SFTS, with particular concern emerging over myocardial injury. While elevated cardiac biomarkers like lactate dehydrogenase (LDH) and creatine kinase (CK) have been noted in fatal cases, the role of cardiac troponin (cTn), a marker of myocardial damage, in predicting early mortality within the first week of symptoms remains less explored.
To address these gaps, a comprehensive nationwide multicenter study was conducted across northern China. Led by a collaborative network of medical centers, the study aimed to investigate the incidence and prognostic value of myocardial injury markers, specifically cTnI, in SFTS patients. The goal was to characterize patterns of myocardial injury and their association with early in-hospital mortality, potentially paving the way for improved risk stratification and clinical management.
Methods
This retrospective observational cohort study spanned from May 2011 to October 2022, encompassing data from six infectious disease departments in northern China. Eligible patients met specific criteria: acute fever (>37.5°C for >24 hours) with thrombocytopenia (platelet count < 100 × 10^9/L) and confirmed SFTSV infection. Exclusions included prior hematologic disorders, hepatitis, autoimmune diseases, and incomplete data. Ethical approval and informed consent were obtained, aligning with the Declaration of Helsinki.
Data collected from electronic medical records included demographic details, clinical profiles, treatments, complications, and outcomes. Myocardial injury was defined by elevated levels of cardiac biomarkers such as cTnI, AST, LDH, CK-MB, and CK. The primary endpoint was in-hospital all-cause mortality within seven days. Statistical analyses utilized various methods including Mann–Whitney U-test, Chi-square test, logistic regression, and Cox regression to assess predictors of myocardial injury and the impact of myocardial indicators on early mortality risk.
The dataset was divided into training and test sets for model development, evaluating prognostic models based on individual biomarkers and combinations thereof. Measures such as brier score, calibration curve, concordance index, and ROC curve were employed. Optimal cut-off points for myocardial enzymes were determined using maximally selected rank statistics. Statistical significance was set at P < 0.05, with analyses performed using SAS and R software, and visualizations created with Surfer.
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