Hyperferritinemia as a Diagnostic Marker for Severe Fever with Thrombocytopenia Syndrome

Abstract

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging viral disease in East Asia with high mortality. Few studies have examined markers that suggest SFTS in febrile patients. To determine useful biochemical markers for SFTS, patients aged 18 years or older with SFTS or microbiologically confirmed community-onset bacteremia with thrombocytopenia (BT) at presentation between June 2013 and December 2015 were included from two tertiary university hospitals in Republic of Korea retrospectively. Eleven patients with SFTS and 62 patients with bacteremia and thrombocytopenia were identified in the study period. Age and sex did not show significant difference among two groups. Fever was more commonly observed but comorbidities were less common in SFTS than in BT (P < 0.05, each). The areas under the curves of serum ferritin, C-reactive protein, white blood cell count, serum procalcitonin, and fibrinogen were above 0.9, indicating the discriminative power of these biomarkers (1.000, 0.991, 0.963, 0.931, and 0.934, resp., all P < 0.05). The optimal cutoff value of serum ferritin was 3,822 ng/mL in this study. These results suggest that hyperferritinemia is a typical laboratory feature of SFTS, and the serum ferritin level can be used as a marker for clinicians suspecting SFTS.

Risk Factors and Clinical Characteristics of Severe Fever with Thrombocytopenia Syndrome

“…Like other studies, 15 except for abnormal blood routine, our data also have shown alanine aminotransferase (ALT), AST, LDH, creatine phosphokinase (CK), D-Dimer, APTT and serum ferritin are elevated. They are all useful laboratory markers though lack specificity.…”

“…Person-to-person transmission of SFTSV occurs rarely through contact with infected blood, bloody respiratory secretions, cadaveric blood 11,12 and probable aerosol, 13,14 which highlight the importance of adding universal precaution including airborne precaution and full personal protective equipment. Like other studies, 15 except for abnormal blood routine, our data also have shown alanine aminotransferase (ALT), AST, LDH, creatine phosphokinase (CK), D-Dimer, APTT and serum ferritin are elevated. They are all useful laboratory markers though lack specificity.…”

Severe fever with thrombocytopenia syndrome: comparison with scrub typhus and clinical diagnostic prediction

“…However, our concentration on moderate to severe cases might have greater clinical impacts in practice. Third, we did not evaluate other parameters such as activated partial thromboplastin time or ferritin, which have also been suggested as useful markers for SFTS, because the previous scrub typhus studies did not include those variables [21, 41]. However, these laboratory variables are not readily available at a point of care or are not necessary for usual clinical practices in the primary care settings where the confirmatory assays for both diseases are not available.…”

Clinical Update of Severe Fever with Thrombocytopenia Syndrome

“…Laboratory findings relative to most SFTS patients revealed thrombocytopenia (<100,000/mm 3 ) and leukopenia (<4000/mm 3 ), accompanied by elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) levels and acute kidney injury. In addition, lactate dehydrogenase (LDH) and ferritin levels also increase, and prolonged activated partial thromboplastin time (aPTT) and proteinuria with or without hematuria can be observed [ 2 , 64 , 66 ]. Chest radiographs in patients with SFTS primarily show cardiomegaly with or without pericardial effusion and patchy consolidation with ground-glass opacity (GGO), which helps in the early differentiation of SFTS from scrub typhus — which is characterized by interstitial pneumonia on chest radiographs [ 67 ].…”