title: Clinical progression and predictors of death in patients with severe fever with thrombocytopenia syndrome in China.
abstract: BACKGROUND
  Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease of which the clinical progression and factors related to death are still unclear.
  
  
  OBJECTIVE
  To identify the clinical progression of SFTS and explore predictors of fatal outcome throughout the disease progress.
  
  
  METHODS
  A prospective study was performed in a general hospital located in Xinyang city during 2011-2013. Confirmed SFTS patients were recruited and laboratory parameters that were commonly evaluated in clinical practice were collected. The clinical progression was determined based on analysis of dynamic profiles and Friedman's test. At each clinical stage, the laboratory features that could be used to predict fatal outcome of SFTS patients were identified by stepwise discriminant analysis.
  
  
  RESULTS
  Totally 257 survivors and 54 deceased SFTS patients were recruited and the data of 11 clinical and laboratory parameters along their entire disease course were consecutively collected. Three clinical stages (day 1-5 post onset, day 6-11 post onset and day 12 to hospital discharge) were determined based on distinct clinical parameters evaluations. Multivariate discriminant analysis at each clinical stage disclosed the indicators of the fatal outcome as decreased platelet counts at early stage, older age and increased AST level at middle stage, and decreased lymphocyte percentage and increased LDH level at late stage.
  
  
  CONCLUSIONS
  The significant indicators at three clinical stages could be used to assist identifying the patients with high risk of death. This knowledge might help to perform supportive treatment and avoid fatality.
authors.affiliation: The 154 Hospital, People's Liberation Army, Xinyang 464000, PR China.
authors.forename: Ning
authors.initials: N
authors.lastname: Cui
authors.affiliation: Consulting Center of Biomedical Statistics, Academy of Military Medical Sciences, Beijing 100850, PR China.
authors.forename: Xiao-Lei
authors.initials: XL
authors.lastname: Bao
authors.affiliation: The 154 Hospital, People's Liberation Army, Xinyang 464000, PR China.
authors.forename: Zhen-Dong
authors.initials: ZD
authors.lastname: Yang
authors.affiliation: School of Public Health, Peking University, Beijing 100191, PR China.
authors.forename: Qing-Bin
authors.initials: QB
authors.lastname: Lu
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China.
authors.forename: Chun-Yan
authors.initials: CY
authors.lastname: Hu
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China; Graduate School of Anhui Medical University, Hefei, PR China.
authors.forename: Li-Yuan
authors.initials: LY
authors.lastname: Wang
authors.affiliation: The 154 Hospital, People's Liberation Army, Xinyang 464000, PR China.
authors.forename: Bing-Jun
authors.initials: BJ
authors.lastname: Wang
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China; Graduate School of Anhui Medical University, Hefei, PR China.
authors.forename: Hong-Yu
authors.initials: HY
authors.lastname: Wang
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China.
authors.forename: Kun
authors.initials: K
authors.lastname: Liu
authors.affiliation: The 154 Hospital, People's Liberation Army, Xinyang 464000, PR China.
authors.forename: Chun
authors.initials: C
authors.lastname: Yuan
authors.affiliation: The 154 Hospital, People's Liberation Army, Xinyang 464000, PR China.
authors.forename: Xue-Juan
authors.initials: XJ
authors.lastname: Fan
authors.affiliation: The 154 Hospital, People's Liberation Army, Xinyang 464000, PR China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
authors.affiliation: The 154 Hospital, People's Liberation Army, Xinyang 464000, PR China.
authors.forename: Lan
authors.initials: L
authors.lastname: Zhang
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China.
authors.forename: Xiao-Ai
authors.initials: XA
authors.lastname: Zhang
authors.affiliation: Consulting Center of Biomedical Statistics, Academy of Military Medical Sciences, Beijing 100850, PR China.
authors.forename: Liang-Ping
authors.initials: LP
authors.lastname: Hu
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China. Electronic address: lwbime@163.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China. Electronic address: caowc@bmi.ac.cn.
authors.forename: Wu-Chun
authors.initials: WC
authors.lastname: Cao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis*; D002044:Bunyaviridae Infections / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology / Q000821:virology; D002648:Child; D002681:China; D005260:Female; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D016856:Phlebovirus / Q000302:isolation & purification*; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Clinical progression; Predictors of death; SFTS