Giuseppe
Emeritus
[Source: Clinical Infectious Diseases Journal, full page: (LINK). Abstract, edited.]
Case fatality and effectiveness of ribavirin in hospitalized patients with severe fever with thrombocytopenia syndrome in China
Qing-Bin Lu 1,#, Ning Cui 2,#, Hao Li 1,#, Li-Yuan Wang 1,3, Kun Liu 1, Zhen-Dong Yang 2, Bing-Jun Wang 2, Hong-Yu Wang 1,3, Yao-Yun Zhang 1,3, Lu Zhuang 1, Chun-Yan Hu 1, Chun Yuan 2, Xue-Juan Fan 2, Zhen Wang 2, Lan Zhang 2, Xiao-Ai Zhang 1, David H. Walker 4, Wei Liu 1,*, and Wu-Chun Cao 1,*
Author Affiliations: <SUP>1</SUP>State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, P. R. China <SUP>2</SUP>The 154 Hospital, People's Liberation Army, Xinyang, 464000, P. R. China <SUP>3</SUP>Graduate School of Anhui Medical University, Hefei, P. R. China <SUP>4</SUP>Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555-0609, USA
*Correspondence author: Wu-Chun Cao, Ph.D., M.D, Professor and Director, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District; Beijing 100071, P. R. China. Tel: +86-10-63896082, Fax: +86-10-63896082, E-mail: caowc@bmi.ac.cn, Wei Liu, M.D, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District; Beijing 100071, P. R. China. Tel: +86-10-63896082, Fax: +86-10-63896082, E-mail: lwbime@163.com
# These authors contributed equally to this work.
Abstract
Background.
The wider distribution and high case fatality rate have made severe fever with thrombocytopenia syndrome (SFTS) a significant public health problem. The study is designed to identify the predictors of fatal outcome and to evaluate the effectiveness of antiviral therapy in treating the SFTSV infected patients.
Method.
A cross-sectional study was performed in a general hospital located in Xinyang city with largest SFTS patients number during 2011-2012. The primary outcome for the treatment effect analysis was death. Other outcomes included sequential platelet levels, and viral loads observed throughout the hospitalization, and the period in days for platelet count return to normal level after starting ribavirin therapy.
Results.
Totally 311 SFTSV infected cases were included in the study. The most frequent clinical presentations were fever, weakness, myalgia and gastrointestinal symptoms. Each patient had both or either of thrombocytopenia and leucopenia. The case fatality ratio (CFR) was 17.4% (95% CI: 13.1%-21.6%). Older age (OR, 1.061, 95%CI, 1.023-1.099, P=0.001), decreased level of consciousness (OR, 5.397, 95%CI, 2.660-10.948, P<0.001), elevated levels of LDH (>1200 U/L) (OR, 2.620, 95%CI, 1.073-6.399, P=0.035 ), and CK (>800 U/L) (OR, 2.328, 95%CI, 1.129-4.800, P=0.022) were significantly associated with fatal outcome. The CFRs were similar between patients who received ribavirin or received no ribavirin therapy. Ribavirin treatment showed no significant effect on either platelet counts or viral loads during the hospitalization in either fatal or non-fatal cases.
Conclusions.
These findings can improve the knowledge on the fatal outcome discrimination and the use of antiviral drug for SFTS patients.
Received April 26, 2013. Accepted August 1, 2013.
? The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
For Permissions, please e-mail: journals.permissions@oup.com.
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Case fatality and effectiveness of ribavirin in hospitalized patients with severe fever with thrombocytopenia syndrome in China
Qing-Bin Lu 1,#, Ning Cui 2,#, Hao Li 1,#, Li-Yuan Wang 1,3, Kun Liu 1, Zhen-Dong Yang 2, Bing-Jun Wang 2, Hong-Yu Wang 1,3, Yao-Yun Zhang 1,3, Lu Zhuang 1, Chun-Yan Hu 1, Chun Yuan 2, Xue-Juan Fan 2, Zhen Wang 2, Lan Zhang 2, Xiao-Ai Zhang 1, David H. Walker 4, Wei Liu 1,*, and Wu-Chun Cao 1,*
Author Affiliations: <SUP>1</SUP>State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, P. R. China <SUP>2</SUP>The 154 Hospital, People's Liberation Army, Xinyang, 464000, P. R. China <SUP>3</SUP>Graduate School of Anhui Medical University, Hefei, P. R. China <SUP>4</SUP>Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555-0609, USA
*Correspondence author: Wu-Chun Cao, Ph.D., M.D, Professor and Director, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District; Beijing 100071, P. R. China. Tel: +86-10-63896082, Fax: +86-10-63896082, E-mail: caowc@bmi.ac.cn, Wei Liu, M.D, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District; Beijing 100071, P. R. China. Tel: +86-10-63896082, Fax: +86-10-63896082, E-mail: lwbime@163.com
# These authors contributed equally to this work.
Abstract
Background.
The wider distribution and high case fatality rate have made severe fever with thrombocytopenia syndrome (SFTS) a significant public health problem. The study is designed to identify the predictors of fatal outcome and to evaluate the effectiveness of antiviral therapy in treating the SFTSV infected patients.
Method.
A cross-sectional study was performed in a general hospital located in Xinyang city with largest SFTS patients number during 2011-2012. The primary outcome for the treatment effect analysis was death. Other outcomes included sequential platelet levels, and viral loads observed throughout the hospitalization, and the period in days for platelet count return to normal level after starting ribavirin therapy.
Results.
Totally 311 SFTSV infected cases were included in the study. The most frequent clinical presentations were fever, weakness, myalgia and gastrointestinal symptoms. Each patient had both or either of thrombocytopenia and leucopenia. The case fatality ratio (CFR) was 17.4% (95% CI: 13.1%-21.6%). Older age (OR, 1.061, 95%CI, 1.023-1.099, P=0.001), decreased level of consciousness (OR, 5.397, 95%CI, 2.660-10.948, P<0.001), elevated levels of LDH (>1200 U/L) (OR, 2.620, 95%CI, 1.073-6.399, P=0.035 ), and CK (>800 U/L) (OR, 2.328, 95%CI, 1.129-4.800, P=0.022) were significantly associated with fatal outcome. The CFRs were similar between patients who received ribavirin or received no ribavirin therapy. Ribavirin treatment showed no significant effect on either platelet counts or viral loads during the hospitalization in either fatal or non-fatal cases.
Conclusions.
These findings can improve the knowledge on the fatal outcome discrimination and the use of antiviral drug for SFTS patients.
Received April 26, 2013. Accepted August 1, 2013.
? The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
For Permissions, please e-mail: journals.permissions@oup.com.
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