[Source: PLOS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]
OPEN ACCESS / PEER-REVIEWED / RESEARCH ARTICLE
A nomogram to predict mortality in patients with severe fever with thrombocytopenia syndrome at the early stage—A multicenter study in China
Lin Wang , Gang Wan , Yi Shen , Zhenghua Zhao , Ling Lin , Wei Zhang, Rui Song, Di Tian, Jing Wen, Yongxiang Zhao, Xiaoli Yu, Li Liu, Yang Feng, [ … ], Wei Li
Published: November 25, 2019 / DOI: https://doi.org/10.1371/journal.pntd.0007829 / This is an uncorrected proof.
Severe fever with thrombocytopenia syndrome (SFTS) caused by the SFTS virus is an emerging infectious disease that was first identified in the rural areas of China in 2011. Severe cases often result in death due to multiple organ failure. To date, there are still numerous problems remain unresolved in SFTS, including unclear pathogenesis, lack of specific treatment, and no effective vaccines available.
To analyze the clinical information of patients with early-stage SFTS and to establish a nomogram for the mortality risk.
Between April 2011 and December 2018, data on consecutive patients who were diagnosed with SFTS were prospectively collected from five medical centers distributed in central and northeastern China. Multivariable Cox analyses were used to identify the factors independently associated with mortality. A nomogram for mortality was established using those factors.
During the study period, 429 consecutive patients were diagnosed with SFTS at the early stage of the disease (within 7 days of fever), among whom 69 (16.1%) died within 28 days. The multivariable Cox proportional hazard regression analysis showed that low lymphocyte percentage, early-stage encephalopathy, and elevated concentration of serum LDH and BUN were independent risk factors for fatal outcomes. Received-operating characteristic curves for 7-, 14-, and 28-days survival had AUCs of 0.944 (95% CI: 0.920–0.968), 0.924 (95% CI: 0.896–0.953), and 0.924 (95% CI: 0.895–0.952), respectively. Among low-risk patients, 6 patients died (2.2%). Among moderate-risk patients, 25 patients died (24.0%, hazard ratio (HR) = 11.957). Among high-risk patients, the mortality rate was 69.1% (HR = 57.768).
We established a simple and practical clinical scoring system, through which we can identify critically ill patients and provide intensive medical intervention for patients as soon as possible to reduce mortality.
We established a SFTS nomogram scoring system, which is the first nomogram for this disease. According to this nomogram, patients were divided into three levels of mortality risk: low, moderate, and high. This scoring system is helpful to identify critically ill patients, allowing for early intervention and intensive care, which may contribute to reducing the mortality of SFTS.
Citation: Wang L, Wan G, Shen Y, Zhao Z, Lin L, Zhang W, et al. (2019) A nomogram to predict mortality in patients with severe fever with thrombocytopenia syndrome at the early stage—A multicenter study in China. PLoS Negl Trop Dis 13(11): e0007829. https://doi.org/10.1371/journal.pntd.0007829
Editor: Benjamin L. Makepeace, University of Liverpool, UNITED KINGDOM
Received: April 12, 2019; Accepted: October 4, 2019; Published: November 25, 2019
Copyright: © 2019 Wang 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.
Funding: This study was supported by the Special Fund For High-level Talents in Beijing Health System Project (2011-3-079), Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (XMLX201502 and XMLX201602) and the National Science and Technology Major Project of China (2018ZX09711003). 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: SFTS; China.