Association of liver function and prognosis in patients with severe fever with thrombocytopenia syndrome

PLoS Negl Trop Dis. 2024 Apr 16;18(4):e0012068. doi: 10.1371/journal.pntd.0012068. eCollection 2024 Apr.

Abstract

Objectives: Severe fever with thrombocytopenia syndrome (SFTS) is an epidemic emerging infectious disease with high mortality rate. We investigated the association between liver injury and clinical outcomes in patients with SFTS.

Methods: A total of 291 hospitalized SFTS patients were retrospectively included. Cox proportional hazards model was adopted to identify risk factors of fatal outcome and Kaplan-Meier curves were used to estimate cumulative risks.

Results: 60.1% of patients had liver injury at admission, and the median alanine transaminase, aspartate aminotransferase (AST), alkaline phosphatase (ALP), and total bilirubin (TBil) levels were 76.4 U/L, 152.3 U/L, 69.8 U/L and 9.9 μmol/L, respectively. Compared to survivors, non-survivors had higher levels of AST (253.0 U/L vs. 131.1 U/L, P < 0.001) and ALP (86.2 U/L vs. 67.9 U/L, P = 0.006), higher proportion of elevated ALP (20.0% vs. 4.4%, P < 0.001) and liver injury (78.5% vs. 54.9%, P = 0.001) at admission. The presence of liver injury (HR 2.049, P = 0.033) at admission was an independent risk factor of fatal outcome.

Conclusions: Liver injury was a common complication and was strongly associated with poor prognosis in SFTS patients. Liver function indicators should be closely monitored for SFTS patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Alanine Transaminase / blood
  • Alkaline Phosphatase / blood
  • Aspartate Aminotransferases / blood
  • Bilirubin / blood
  • Female
  • Humans
  • Liver / pathology
  • Liver Function Tests
  • Male
  • Middle Aged
  • Phlebovirus
  • Prognosis
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Severe Fever with Thrombocytopenia Syndrome* / epidemiology
  • Severe Fever with Thrombocytopenia Syndrome* / mortality
  • Severe Fever with Thrombocytopenia Syndrome* / virology

Substances

  • Alkaline Phosphatase
  • Aspartate Aminotransferases
  • Alanine Transaminase
  • Bilirubin

Grants and funding

RH wishes to acknowledge the support from Nanjing Medical Science and Technique Development Foundation (No. QRX17121) and Natural Science Foundation of Jiangsu Province (No. BK20211004). CW wishes to acknowledge the support from Nanjing Important Science & Technology Specific Projects (No. 2021‐11005). YX wishes to acknowledge the support from the Clinical Trials from the Affiliated Drum Tower Hospital, Medical School of Nanjing University (2022-LCYJ-DBZ-06). All the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.