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Abstract：
BACKGROUND: Epstein-Barr virus (EBV) can be reactivated and proliferated with fatal outcome in immuno-compromised people, but the clinical consequences of EBV infection in patients with severe fever with thrombocytopenia syndrome (SFTS) remain uncertain. In this study, we investigated the infection rate, the influence and the early predictors of EBV infection in SFTS patients.
METHODS: In this retrospective study, SFTS patients who were treated in the First Affiliated Hospital of Nanjing Medical University from May 2011 to August 2021 were enrolled and divided into infected and non-infected groups. We compared the demographic characteristics, clinical manifestations and signs, laboratory tests and prognosis, and explored the risk factors of EBV infection by receiver operating characteristic (ROC) curve and logistic regression.
RESULTS: A total of 120 hospitalized SFTS patients with EBV-DNA testing were enrolled in this study. Patients with EBV infection had statistically significant higher mortality rate (32.0% vs. 11.43%, P = 0.005). Compared with the non-infected group, the EBV-infected group had higher levels of C-reactive protein (CRP), creatine-kinase (CK), fasting blood glucose (FBG), blood urea nitrogen (BUN), D-dimer, and CD56+ cell counts, lower levels of immunoglobulin G (IgG), IgM, complement 3 (C3), and C4. The proportion of patients with age ≥ 60 years and ferritin > 1500.0 ng/ml in the EBV-infected group was significantly higher than that in the non-infected group. The results of ROC analysis showed that the cut-off values of CRP, IgG, C3, C4, and CD56+ cell counts to predict EBV infection were 13.2 mg/l, 12.5 g/l, 1.1 g/l, 0.6 g/l, 0.3 g/l, and 94.0 cells/µl. Multivariable logistic analysis showed that age ≥ 60 years old, CRP > 13.2 mg/l, BUN > 5.4 mmol/l, ferritin > 1500.0 ng/ml, IgG < 12.5 g/l, IgM < 1.1 g/l, C4 < 0.3 g/l, and CD56+ cell counts > 94.0 cells/µl were the independent risk factors of EBV infection in SFTS patients.
CONCLUSIONS: SFTS combined with EBV infection is associated with high morbidity and mortality. It is necessary to strengthen screening for EBV infection and its early predictive markers after admission in SFTS patients.
METHODS: In this retrospective study, SFTS patients who were treated in the First Affiliated Hospital of Nanjing Medical University from May 2011 to August 2021 were enrolled and divided into infected and non-infected groups. We compared the demographic characteristics, clinical manifestations and signs, laboratory tests and prognosis, and explored the risk factors of EBV infection by receiver operating characteristic (ROC) curve and logistic regression.
RESULTS: A total of 120 hospitalized SFTS patients with EBV-DNA testing were enrolled in this study. Patients with EBV infection had statistically significant higher mortality rate (32.0% vs. 11.43%, P = 0.005). Compared with the non-infected group, the EBV-infected group had higher levels of C-reactive protein (CRP), creatine-kinase (CK), fasting blood glucose (FBG), blood urea nitrogen (BUN), D-dimer, and CD56+ cell counts, lower levels of immunoglobulin G (IgG), IgM, complement 3 (C3), and C4. The proportion of patients with age ≥ 60 years and ferritin > 1500.0 ng/ml in the EBV-infected group was significantly higher than that in the non-infected group. The results of ROC analysis showed that the cut-off values of CRP, IgG, C3, C4, and CD56+ cell counts to predict EBV infection were 13.2 mg/l, 12.5 g/l, 1.1 g/l, 0.6 g/l, 0.3 g/l, and 94.0 cells/µl. Multivariable logistic analysis showed that age ≥ 60 years old, CRP > 13.2 mg/l, BUN > 5.4 mmol/l, ferritin > 1500.0 ng/ml, IgG < 12.5 g/l, IgM < 1.1 g/l, C4 < 0.3 g/l, and CD56+ cell counts > 94.0 cells/µl were the independent risk factors of EBV infection in SFTS patients.
CONCLUSIONS: SFTS combined with EBV infection is associated with high morbidity and mortality. It is necessary to strengthen screening for EBV infection and its early predictive markers after admission in SFTS patients.
摘要：
背景：爱泼斯坦-巴尔病毒（EBV）可以在免疫受损的人群中重新激活并增殖，但重症发热伴血小板减少综合征(SFTS)患者EBV感染的临床后果仍不确定.在这项研究中,我们调查了感染率，SFTS患者EBV感染的影响及早期预测因素。
方法：在这项回顾性研究中，选取2011年5月至2021年8月在南京医科大学第一附属医院接受治疗的SFTS患者，分为感染组和非感染组。我们比较了人口特征，临床表现和体征，实验室检查和预后，通过受试者工作特征(ROC)曲线和logistic回归分析探讨EBV感染的危险因素。
结果：本研究共纳入120例接受EBV-DNA检测的住院SFTS患者。EBV感染患者的死亡率有统计学意义（32.0%vs.11.43%，P=0.005)。与未感染组相比，EBV感染组有较高水平的C反应蛋白（CRP），肌酸激酶（CK），空腹血糖（FBG），血尿素氮(BUN),D-二聚体,和CD56+细胞计数，较低水平的免疫球蛋白G（IgG），IgM,补码3（C3），和C4。EBV感染组年龄≥60岁、铁蛋白>1500.0ng/ml的患者比例明显高于非感染组。ROC分析结果显示,CRP的临界值,IgG,预测EBV感染的C3，C4和CD56+细胞计数为13.2mg/l，12.5g/l,1.1g/l,0.6g/l,0.3g/l,和94.0细胞/μl。多因素Logistic分析显示年龄≥60岁,CRP>13.2mg/l，BUN>5.4mmol/l,铁蛋白>1500.0ng/ml，IgG<12.5g/l，IgM<1.1g/l，C4<0.3g/l，CD56+细胞计数>94.0细胞/μl是SFTS患者EBV感染的独立危险因素。
结论：SFTS合并EBV感染与高发病率和死亡率相关。有必要加强SFTS患者入院后EBV感染及其早期预测指标的筛查。
方法：在这项回顾性研究中，选取2011年5月至2021年8月在南京医科大学第一附属医院接受治疗的SFTS患者，分为感染组和非感染组。我们比较了人口特征，临床表现和体征，实验室检查和预后，通过受试者工作特征(ROC)曲线和logistic回归分析探讨EBV感染的危险因素。
结果：本研究共纳入120例接受EBV-DNA检测的住院SFTS患者。EBV感染患者的死亡率有统计学意义（32.0%vs.11.43%，P=0.005)。与未感染组相比，EBV感染组有较高水平的C反应蛋白（CRP），肌酸激酶（CK），空腹血糖（FBG），血尿素氮(BUN),D-二聚体,和CD56+细胞计数，较低水平的免疫球蛋白G（IgG），IgM,补码3（C3），和C4。EBV感染组年龄≥60岁、铁蛋白>1500.0ng/ml的患者比例明显高于非感染组。ROC分析结果显示,CRP的临界值,IgG,预测EBV感染的C3，C4和CD56+细胞计数为13.2mg/l，12.5g/l,1.1g/l,0.6g/l,0.3g/l,和94.0细胞/μl。多因素Logistic分析显示年龄≥60岁,CRP>13.2mg/l，BUN>5.4mmol/l,铁蛋白>1500.0ng/ml，IgG<12.5g/l，IgM<1.1g/l，C4<0.3g/l，CD56+细胞计数>94.0细胞/μl是SFTS患者EBV感染的独立危险因素。
结论：SFTS合并EBV感染与高发病率和死亡率相关。有必要加强SFTS患者入院后EBV感染及其早期预测指标的筛查。
