Abstract：
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease with high case fatality rate. Unfortunately, no vaccine or antiviral specifically targeting SFTS virus (SFTSV) are available for the time being. Our objective was to investigate the association between clinical laboratory parameters and fatality of SFTS patients.
The systematic review was conducted in accordance with The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. We searched (from inception to 24th February 2022) Web of Science, PubMed, National Knowledge Infrastructure databases and Wan Fang Data for relevant researchers on SFTS. Studies were eligible if they reported on laboratory parameters of SFTS patients and were stratified by clinical outcomes. A modified version of Newcastle-Ottawa scale was used to evaluate the quality of included studies. Standardized mean difference (SMD) was used to evaluate the association between laboratory parameters and outcomes. The between-study heterogeneity was evaluated quantitatively by standard Chi-square and the index of heterogeneity (I2). Heterogeneity was explored by subgroup and sensitivity analyses, and univariable meta-regression. Publication bias was determined using funnel plots and Egger\'s test.
We identified 34 relevant studies, with over 3300 participants across three countries. The following factors were strongly (SMD>1 or SMD<-0.5) and significantly (P<0.05) associated mortality: thrombin time (TT) (SMD = 1.53), viral load (SMD = 1.47), activated partial-thromboplastin time (APTT) (SMD = 1.37), aspartate aminotransferase (AST) (SMD = 1.19), lactate dehydrogenase (LDH) (SMD = 1.13), platelet count (PLT) (SMD = -0.47), monocyte percentage (MON%) (SMD = -0.47), lymphocyte percentage (LYM%) (SMD = -0.46) and albumin (ALB) (SMD = -0.43). Alanine aminotransferase, AST, creatin phosphokinase, LDH, PLT, partial-thromboplastin time and viral load contributed to the risk of dying of SFTS patients in each subgroup analyses. Sensitivity analysis demonstrated that the results above were robust.
The abnormal levels of viral load, PLT, coagulation function and liver function, significantly increase the risk of SFTS mortality, suggesting that SFTS patients with above symptoms call for special concern.
The systematic review was conducted in accordance with The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. We searched (from inception to 24th February 2022) Web of Science, PubMed, National Knowledge Infrastructure databases and Wan Fang Data for relevant researchers on SFTS. Studies were eligible if they reported on laboratory parameters of SFTS patients and were stratified by clinical outcomes. A modified version of Newcastle-Ottawa scale was used to evaluate the quality of included studies. Standardized mean difference (SMD) was used to evaluate the association between laboratory parameters and outcomes. The between-study heterogeneity was evaluated quantitatively by standard Chi-square and the index of heterogeneity (I2). Heterogeneity was explored by subgroup and sensitivity analyses, and univariable meta-regression. Publication bias was determined using funnel plots and Egger\'s test.
We identified 34 relevant studies, with over 3300 participants across three countries. The following factors were strongly (SMD>1 or SMD<-0.5) and significantly (P<0.05) associated mortality: thrombin time (TT) (SMD = 1.53), viral load (SMD = 1.47), activated partial-thromboplastin time (APTT) (SMD = 1.37), aspartate aminotransferase (AST) (SMD = 1.19), lactate dehydrogenase (LDH) (SMD = 1.13), platelet count (PLT) (SMD = -0.47), monocyte percentage (MON%) (SMD = -0.47), lymphocyte percentage (LYM%) (SMD = -0.46) and albumin (ALB) (SMD = -0.43). Alanine aminotransferase, AST, creatin phosphokinase, LDH, PLT, partial-thromboplastin time and viral load contributed to the risk of dying of SFTS patients in each subgroup analyses. Sensitivity analysis demonstrated that the results above were robust.
The abnormal levels of viral load, PLT, coagulation function and liver function, significantly increase the risk of SFTS mortality, suggesting that SFTS patients with above symptoms call for special concern.
摘要：
严重发热伴血小板减少综合征（SFTS）是一种新兴的蜱传传染病，病死率高。不幸的是,目前尚无特异性靶向SFTS病毒（SFTSV）的疫苗或抗病毒药物。我们的目的是研究临床实验室参数与SFTS患者病死率之间的关系。
系统评价是根据2020年系统评价和荟萃分析的首选报告项目进行的。我们搜索了（从成立到2022年2月24日）WebofScience，PubMed,国家知识基础设施数据库和SFTS相关研究人员的万方数据。如果研究报告了SFTS患者的实验室参数并按临床结果分层，则研究合格。使用改良版本的纽卡斯尔-渥太华量表来评估纳入研究的质量。标准化平均差（SMD）用于评估实验室参数与结果之间的关联。通过标准卡方和异质性指数（I2）定量评估研究之间的异质性。通过亚组和敏感性分析探索异质性，和单变量元回归。使用漏斗图和Egger检验确定发表偏倚。
我们确定了34项相关研究，来自三个国家的3300多名参与者。以下因素与死亡率密切相关（SMD>1或SMD<-0.5）和显著相关（P<0.05）：凝血酶时间（TT）（SMD=1.53），病毒载量（SMD=1.47），活化部分凝血活酶时间（APTT）（SMD=1.37），天冬氨酸转氨酶（AST）（SMD=1.19），乳酸脱氢酶（LDH）（SMD=1.13），血小板计数（PLT）（SMD=-0.47），单核细胞百分比（MON%）（SMD=-0.47），淋巴细胞百分比（LYM%）（SMD=-0.46）和白蛋白（ALB）（SMD=-0.43）。丙氨酸转氨酶,AST,肌酸磷酸激酶，LDH,PLT,在各亚组分析中,部分凝血活酶时间和病毒载量对SFTS患者死亡风险有影响。敏感性分析表明，上述结果是稳健的。
病毒载量的异常水平，PLT,凝血功能和肝功能，显著增加SFTS死亡率的风险，提示有上述症状的SFTS患者需要特别关注。
系统评价是根据2020年系统评价和荟萃分析的首选报告项目进行的。我们搜索了（从成立到2022年2月24日）WebofScience，PubMed,国家知识基础设施数据库和SFTS相关研究人员的万方数据。如果研究报告了SFTS患者的实验室参数并按临床结果分层，则研究合格。使用改良版本的纽卡斯尔-渥太华量表来评估纳入研究的质量。标准化平均差（SMD）用于评估实验室参数与结果之间的关联。通过标准卡方和异质性指数（I2）定量评估研究之间的异质性。通过亚组和敏感性分析探索异质性，和单变量元回归。使用漏斗图和Egger检验确定发表偏倚。
我们确定了34项相关研究，来自三个国家的3300多名参与者。以下因素与死亡率密切相关（SMD>1或SMD<-0.5）和显著相关（P<0.05）：凝血酶时间（TT）（SMD=1.53），病毒载量（SMD=1.47），活化部分凝血活酶时间（APTT）（SMD=1.37），天冬氨酸转氨酶（AST）（SMD=1.19），乳酸脱氢酶（LDH）（SMD=1.13），血小板计数（PLT）（SMD=-0.47），单核细胞百分比（MON%）（SMD=-0.47），淋巴细胞百分比（LYM%）（SMD=-0.46）和白蛋白（ALB）（SMD=-0.43）。丙氨酸转氨酶,AST,肌酸磷酸激酶，LDH,PLT,在各亚组分析中,部分凝血活酶时间和病毒载量对SFTS患者死亡风险有影响。敏感性分析表明，上述结果是稳健的。
病毒载量的异常水平，PLT,凝血功能和肝功能，显著增加SFTS死亡率的风险，提示有上述症状的SFTS患者需要特别关注。
