[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]
OPEN ACCESS / PEER-REVIEWED / RESEARCH ARTICLE
Preexisting chronic conditions for fatal outcome among SFTS patients: An observational Cohort Study
Shao-Fei Zhang , Zhen-Dong Yang , Mao-Lin Huang , Zhi-Bo Wang, Yuan-Yuan Hu, Dong Miao, Ke Dai, Juan Du, Ning Cui, Chun Yuan, Hao Li, Xiao-Kun Li, Xiao-Ai Zhang, [ … ], Wei Liu
Published: May 28, 2019 / DOI: https://doi.org/10.1371/journal.pntd.0007434 / This is an uncorrected proof.
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that is caused by a novel bunyavirus SFTSV. Currently our knowledge of the host-related factors that influence the pathogenesis of disease is inadequate to allow prediction of fatal outcome. Here we conducted a prospective study of the largest database on the SFTS patients, to identify the presence of comorbidities in SFTS, and estimate their effect on the fatal outcome. Among 2096 patients eligible for inclusion, we identified nine kinds of comorbidities, from which hyperlipidemia (12.2%; 95% CI: 10.8%–13.6%), hypertension (11.0%; 95% CI: 9.6%–12.3%), chronic viral hepatitis (CVH) (9.3%; 95% CI: 8.1%–10.5%), and diabetes mellitus (DM) (6.8%; 95% CI: 5.7%–7.9%) were prevalent. Higher risk of death was found in patients with DM (adjusted OR = 2.304; 95% CI: 1.520–3.492; P<0.001), CVH (adjusted OR = 1.551; 95% CI: 1.053–2.285; P = 0.026) and chronic obstructive pulmonary diseases (COPD) (adjusted OR = 2.170; 95% CI: 1.215–3.872; P = 0.009) after adjusting for age, sex, delay from disease onset to admission and treatment regimens. When analyzing the comorbidities separately, we found that the high serum glucose could augment diseases severity. Compared to the group with max glucose < 7.0 mmol/L, patients with glucose between 7.0–11.1 mmol/L and glucose ≥11.1 mmol/L conferred higher death risk, with the adjusted OR to be 1.467 (95% CI: 1.081–1.989; P = 0.014) and 3.443 (95% CI: 2.427–4.884; P<0.001). Insulin therapy could effectively reduce the risk of severe outcome in DM patients with the adjusted OR 0.146 (95% CI: 0.058–0.365; P<0.001). For CVH patients, severe damage of liver and prolongation of blood coagulation time, as well as high prevalence of bleeding phenotype were observed. These data supported the provocative hypothesis that treating SFTS related complications can attain potentially beneficial effects on SFTS.
SFTS now brings about a substantial global public health concern. Preexisting chronic conditions were thought to increase risk of severe SFTSV infections, however with sparse data mining efforts. In this study, we quantified the frequency of chronic comorbidities in SFTS, estimated their contribution to disease severity, and separately evaluated the effect from diabetes mellitus and chronic viral hepatitis on resulting in fatal outcome.
Citation: Zhang S-F, Yang Z-D, Huang M-L, Wang Z-B, Hu Y-Y, Miao D, et al. (2019) Preexisting chronic conditions for fatal outcome among SFTS patients: An observational Cohort Study. PLoS Negl Trop Dis 13(5): e0007434. https://doi.org/10.1371/journal.pntd.0007434
Editor: Patricia V. Aguilar, University of Texas Medical Branch, UNITED STATES
Received: January 8, 2019; Accepted: May 2, 2019; Published: May 28, 2019
Copyright: © 2019 Zhang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: WL is supported by the China Mega-Project for Infectious Diseases (No. 2018ZX10713002), National Natural Science Foundation of China (No. 81825019 and 81621005), and the Talent Program of Science and Technology of Beijing (No. Z181100006318008, Z171100001117089). HL is supported by National Natural Science Foundation of China (No. 81472005). QBL is supported by National Natural Science Foundation of China (No. 81703274) and Peking University Medicine Seed Fund for Interdisciplinary Research (BMU2018MX009). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Keywords: Bunyavirus; SFTS.