背景:严重发热伴血小板减少综合征(SFTS)是一种新型蜱传传染病,病死率高。尽管在最近的研究中已经报道了一些基于人口统计学和实验室数据的列线图来预测SFTS的预后,纳入基线血清糖化白蛋白(GA)/白蛋白(ALB)比值的风险模型尚未用于预测临床结局.
方法:我院5月收治的214例SFTS患者,2020年11月,2022年纳入本研究。通过实时荧光定量PCR(qRT-PCR)确认SFTS感染。人口特征,收集患者入院后24小时和出院前1~2天的临床和实验室数据,并进行回顾性分析。
结果:Fiffty-7名患者(26.6%)死亡。多因素logistic回归分析显示,年龄,天冬氨酸转氨酶(AST),血糖(GLU),GA/ALB比值,中性粒细胞计数(NEU)和淋巴细胞百分比(LYM%)是死亡的独立危险因素.在R程序中使用RMS软件包创建了由这些因子组成的列线图。该列线图的受试者工作特征(ROC)曲线下面积(AUC)为0.88(95%CI:0.83,0.93)。该模型显示出优异的净收益,正如决策曲线分析所揭示的那样。在入院时高血糖和有糖尿病史的患者亚组中,GA/ALB比率也是临床不良的独立危险因素。通过亚组中的独立风险因素构建列线图。亚组的列线图的AUC显示出不良预后的高预测值。
结论:GA/ALB比值是所有SFTS患者和入院时高血糖和糖尿病病史亚组死亡的独立危险因素。包括GA/ALB比率的列线图对不良临床结果具有较高的预测价值。列线图为不同临床环境下SFTS患者的治疗提供了临床决策依据。
BACKGROUND: Severe fever with thrombocytopenia syndrome (SFTS) is a novel tick-borne infectious disease with a high fatality rate. Although several nomograms based on demographic and laboratory data have been reported to predict the prognosis of SFTS in recent studies, baseline serum glycated albumin (GA)/albumin (ALB) ratio included risk model has not been evaluated for the prediction of clinical outcome.
METHODS: A total of 214 SFTS patients with integral data admitted to our hospital from May, 2020 to November, 2022 were included in this study. SFTS infection was confirmed by real time fluorescent quantitative PCR (qRT-PCR). The demographic characteristics, clinical and laboratory data were collected with in 24 h of admission and 1 to 2 days before discharge and were analysed retrospectively.
RESULTS: Fiffty-seven patients (26.6%) died. Multivariate logistic regression analysis showed that age, aspartate aminotransferase (AST), blood glucose (GLU), GA/ALB ratio, neutrophil counts (NEU) and lymphocyte percentage (LYM%) were the independent risk factors for mortality. A nomogram by these factors was created using RMS package in the R program. Area under the receiver operating characteristic (ROC) curve (AUC) of this nomogram was 0.88 (95% CI: 0.83, 0.93). This model showed the excellent net benefit, as revealed by the decision curve analysis. GA/ALB ratios were also independent risk factors for poor out clinical come in subgroups of patients with hyperglycemia on admission and with diabetes history. Nomograms were constructed by the independent risk factors in the subgroups. AUCs of the nomograms in the subgroups showed high predictive values for adverse prognosis.
CONCLUSIONS: GA/ALB ratios were independent risk factors for mortality in all SFTS patients and subgroups of with hyperglycemia on admission and diabetes history. The nomograms including GA/ALB ratio had high predictive value for adverse clinical outcome.The nomograms provide a basis for clinical decision-making for the treatment of SFTS patients in different clinical settings.