■严重发热伴血小板减少综合征(SFTS)是一种新出现的具有高致死率的传染病。这项研究旨在确定延长活化部分凝血活酶时间(APTT)是否可以预测SFTS死亡率。
■SFTS患者来自中国北方的6家医院。将受试者分为训练队列和5个外部验证队列。采用最小绝对收缩和选择算子Cox回归模型筛选潜在的预后因素。采用多元回归模型分析危险因素。通过Cox回归和随机生存森林(RSF)方法建立预后模型,并对歧视进行了评估,有效性和临床获益。使用时间依赖性受试者工作特征(ROC)曲线来评估变量的预测有效性。
■包括1332例SFTS病例,其中211名患者死亡。筛选了六个潜在的预后因素,和脉搏,呼吸,在两个训练队列中,APTT和天冬氨酸转氨酶(AST)与死亡率独立相关(烟台,N=791)和外部验证队列(N=541)。APTT与病死率稳定相关(HR:1.039-1.144;所有P<0.01)在每五个亚验证队列中(丹东,大连,泰安,青岛和北京)。APTT变量的RSF模型,AST,脉搏和呼吸有相当大的预后效果,APTT显示出最高的预后能力,其7天和14天生存期的曲线下面积分别为0.848和0.787,分别。使用50s作为最佳截止值,在高APTT和低APTT之间发现了生存差异。
■SFTS患者APTT时间延长,这是死亡的独立危险因素。建议将APTT≥50作为生物标志物,以提醒医生更积极地监测和治疗患者,以改善临床预后。
UNASSIGNED: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with high lethality. This study aimed to determine whether prolonged activated partial thromboplastin time (
APTT) predicted SFTS mortality.
UNASSIGNED: SFTS patients were enrolled from 6 hospitals in the north China. Subjects were divided into training cohort and 5 externally validation cohorts. The least absolute shrinkage and selection operator Cox regression model was performed to screen potential prognostic factors. Risk factors were analyzed using multivariable regression models. Prognostic models were established by Cox regression and random survival forest (RSF) methods, and evaluated regarding discrimination, validity and clinical benefit. Time-dependent receiver operating characteristic (ROC) curve was used to evaluate the predictive effectiveness of variables.
UNASSIGNED: 1332 SFTS cases were included, in which 211 patients died. Six potential prognostic factors were screened, and pulse, breath,
APTT and aspartic transaminase (AST) were independently associated with mortality in both training cohort (Yantai, N = 791) and external validation cohort (N = 541).
APTT was steadily correlated with the fatality (HR: 1.039-1.144; all P < 0.01) in each five sub-validation cohorts (Dandong, Dalian, Tai\'an, Qingdao and Beijing). RSF model with variables of
APTT, AST, pulse and breath had considerable prognostic effectiveness, which
APTT showed the highest prognostic ability with the area under the curve of 0.848 and 0.787 for 7-day and 14-day survival, respectively. Survival differences were found between high and low levels of APTT for mortality using 50s as the optimal cut-off.
UNASSIGNED: SFTS patients have prolonged APTT, which is an independent risk factor for fatality. APTT≥50s was recommended as a biomarker to remind physicians to monitor and treat patients more aggressively to improve clinical prognosis.