Close correlation between development of MODS during the initial 72 h of hospitalization and hospital mortality in severe fever with thrombocytopenia syndrome

Abstract

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.

Circulating regulatory T cells in patients with severe fever with thrombocytopenia syndrome

“…Dynamic specimen collection (more than twice per patient) was performed in 15 of the 30 patients enrolled. The demographic data showed that the average age of severe cases was slightly higher than that of non-severe cases, and we have confirmed that advanced age was one of the main risk factors for the development of MODS and death [6]. Platelet counts in patients with severe disease were lower than in those with non-severe disease ( Table I).…”

“…The condition of some patients with severe SFTS deteriorates rapidly and quickly proceeds to multiple organ dysfunction syndrome (MODS), even ending with multi-organ failure (MOF) and death [3]. Studies have shown that the occurrence of MODS during initial hospitalization within 72 h is closely associated with mortality [6]. authors have found that SFTS is associated with host immune response, which plays a critical role in determining the severity and clinical outcome of patients who are infected by SFTSV [7,8].…”

An emerging hemorrhagic fever in China caused by a novel bunyavirus SFTSV

“…Patients with SFTS have severe clinical symptoms, and progress rapidly to multiple organ dysfunction syndrome (MODS), with a high fatality rate of 12%-30% [3]. Multiorgan failure is associated with death and the SFTS patients with MODS who died were older and had lower platelet counts than those who survived [28]. Mortality was significantly higher in misdiagnosed SFTS patients than in patients with confirmed SFTS (16% vs. 6.1%, respectively) [28].…”

“…Multiorgan failure is associated with death and the SFTS patients with MODS who died were older and had lower platelet counts than those who survived [28]. Mortality was significantly higher in misdiagnosed SFTS patients than in patients with confirmed SFTS (16% vs. 6.1%, respectively) [28]. The treatment for SFTS is nonspecific and the results of treatment are difficult to evaluate because there have been no cohort studies.…”

A rare fatal case of a novel bunyavirus-associated hemophagocytic lymphohistiocytosis

“…The hemophagocytic macrophages will further decrease the cell number in the three cell lines. Patients with SFTS will have significantly decreased blood platelet counts and tend to suffer from multiorgan failure, which eventually leads to death [8].…”