Analyze On Clinical Laboratory Indicators In Patients With Severe Fever With Thrombocytopenia Syndrome With Different Prognosis And Complications

Background and objectiveSevere fever with thrombocytopenia syndrome（SFTS）is an infectious disease that should be reported,characterized by fever,weakness,leukopenia,thrombocytopenia,gastrointestinal symptoms,andcentral nervous system manifestations.The pathogen of SFTS is a new virus in the family of Bunyaviridae,named SFTS virus（SFTSV）.Recently,human cases have been widely reported in at least 16 provinces in eastern and central China,including Shandong,Zhejiang,Jiangsu,Anhui,Henan,Hubei,and Liaoning provinces,etc.In addition,the disease was also reported in Korea and Japan in2012,and a disease similar to SFTS has been reported in the United States.The incidence of the disease is very high in some epidemic areas with a case-fatality rate of up to 30%,which has posed an increasingly threat to global health.In this study,weanalyzed the clinical laboratory indicators of SFTS patients caused by novel Bunyavirus infection,and focused on comparing the indicators of severe patients with different prognosis.The findings may help to predict poor prognosis for severe patients in the early stage.MethodsTo investigate the clinical laboratory indicators of all diagnosed confirmedly patients in two hospitals,from January 2011 to December 2018,and the differences between groups were analyzed.SPSS 23.0 software was used for statistical analysis.The measurement data obeying the normal distribution was represented by（x?s）and compared with the mean by t-test;the measurement data that did not conform to the normal distribution was represented by M(P₂₅,P₇₅)and analyzed by nonparametric test;the classified counting data was expressed by frequency（percentage）and analyzed by chi square test.Logistic regression analysis（adjusting for age,sex and hospital source）was carried out on the variables with significant test（P<0.05）.α=0.05.Results（1）A total of 168 patients with clinically diagnosed SFTS（117 non-severe cases and 51severe cases）were included in this study.In the severe cases,the prognosis was improved in 30 cases and poor in 21 cases.There were no significant differences in gender and average age between severe and non-severe groups（all P>0.05）.There were no significant differences in gender and average age between the severe group with improved prognosis and the severe group with poor prognosis（all P>0.05）.（2）Comparison of laboratory indexes of severely and non-severely ill patients upon admission Comparison of laboratory indexes of severely and non-severely ill patients upon admission,found that platelets（PLT）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,glutamyl transpeptidase（GGT）,alkaline phosphatase（ALP）,albumin（albumin,ALB）,calcium（Ca）,glucose（GLU）,creatinine（Cr）,blood urea nitrogen（BUN）,lactate dehydrogenase（LDH）,creatine kinase（CK）,creatine Kinase,MB form（CK-MB）,prothrombin time（PT）,time of partial activation of thrombin（APTT）,thrombin time（TT）and occult blood（U-BLD）in severely and non-severely ill patients were significant difference（all P<0.05）.Logistic regression（after adjusting for age,gender and hospital source）of the above-mentioned meaningful（P<0.05）variables,found that there were statistically significant differences in the indexes of PLT,ALP,GLU,Cr,LDH,CK,CK-MB,APTT,TT and U-BLD in the the severe group and non-severe group（all P<0.05）.（3）Comparison of the first and last laboratory indexes of patients with different severe prognosis Comparative analysis of the first laboratory test indexes of patients with different prognosis when they were admitted to the hospital revealed that AST,BUN,LDH,APTT and TT of patients with poor prognosis and improved prognosis were found.The differences in these five indicators were statistically significant（all P<0.05）.A comparative analysis of the indexes of the last laboratory examination before discharge of severely ill patients with different prognosis found that there were statistically significant differences between the two groups（all P<0.05）.Logistic regression was performed on the above-mentioned meaningful（P<0.05）variables（after adjusting for age,gender and hospital source）,and there were statistical significance of differences in the admission laboratory indicators（AST,BUN,LDH,APTT and TT）in the poor prognosis group and the improved prognosis group（all P<0.05）,and the differences among multiple final laboratory indicators were also statistically significant（all P<0.05）.（4）Comparison of clinical symptoms in patients with severe prognosis This study found that the proportion of patients with poor prognosis such as coma,disseminated intravascular coagulation,and heart failure were higher than those with improved prognosis（all P<0.05）.Logistic regression was performed on meaningful clinical features（after adjusting for age,gender,and hospital source）,and it was found that the risk of diffuse intravascular coagulation in the poor prognosis group was higher than that in the improved prognosis group（OR=12.986,95%CI:1.241-135.917,P=0.032）.（5）Comparison of laboratory indexes of 168 patients with different clinical complications on admission This study showed that the levels of C-reactive protein、AST、ALP、P、Cr、LDH、APTT and TT of SFTS patients complicated with heart failure were higher than that of patients without heart failure（all P<0.05）.The levels of ALT,AST,GGT,ALP,CK-MB,LDH,APTT and U-BLD of SFTS patients complicated with respiratory failure were higher than those patients without respiratory failure（all P<0.05）.The levels of ALT,AST,GGT,ALP,GLU,Cr,BUN,CK,CK-MB,LDH,APTT and TT in patients with SFTS complicated with disturbance of consciousness were higher than those in patients with unconsciousness disorders（all P<0.05）,while the level of ALB was lower in patients with unconsciousness disorders（Z=-2.256,P=0.024）.The levels of WBC,ALT,AST,GGT,ALP,CK,CK-MB,LDH,APTT,TT and U-BLD in SFTS patients with DIC were higher than those in patients without DIC（all P<0.05）,while the levels of RBC,PLT and FIB were lower in patients without DIC（all P<0.05）.The levels of ALT,AST,BUN,LDH,APTT,TT and U-BLD in SFTS patients with gastrointestinal bleeding were higher than those in patients without gastrointestinal bleeding（all P<0.05）.Logistic regression（after adjusting for age,gender,and hospital source）of the above-mentioned meaningful laboratory indicators,and found statistically significant differences in the admission laboratory indicators AST,ALP,Cr,LDH,APTT,and TT between the concurrent heart failure group and the non-heart failure group（all P<0.05）;there was a statistically significant difference between the admission laboratory index LDH between the complicated respiratory failure group and the non-respiratory failure group（OR=1.000,95%CI:1.000-1.001,P=0.009）;there werestatistically significant differences in admission laboratory indexes AST,CK,CK-MB and APTTbetween complicated consciousness disorder group and unconscious disorder group（all P<0.05）;there were statistically significant differences among the admission laboratory indexes APTT,TT and U-BLDbetween the complicated gastrointestinal bleeding group and no gastrointestinal bleeding group（all P<0.05）.（6）Comparison of laboratory indexes of 51 severe patients with different clinical complications on admission This study showed that the levels of C-reactive protein,P and LDH of severe SFTS patients complicated with heart failure were higher than that of patients without heart failure（all P<0.05）.There were no significant difference in laboratory indexes between severe SFTS patients complicated with respiratory failure and patients without respiratory failure（all P>0.05）.The level of K in patients with severe SFTS complicated with disturbance of consciousness was higher than those in patients with unconsciousness disorders（Z=-2.057,P=0.040）.The levels of AST,CK,CK-MB,LDH and APTT in severe SFTS patients with DIC were higher than those in severe patients without DIC（all P<0.05）,while the levels of RBC,PLT and FIB were lower in severe patients without DIC（all P<0.05）.The levels of Ca,TT and U-BLD in severe SFTS patients with gastrointestinal bleeding were higher than those in patients without gastrointestinal bleeding（all P<0.05）.Logistic regression was performed on meaningful（P<0.05）of the above laboratory indicators（after adjusting for age,gender,and hospital source）.The high level of TT indicators suggested that severe patients are at risk of complicated gastrointestinal bleeding（OR=1.037,95%CI:1.008-1.066,P=0.013）.ConclusionsBy comparing and analyzing the laboratory examination indexes of patients with different prognosis,it is found that the increase or extension of multiple indexes can not only predict the risk of severe illness at the time of admission,but also indicate the risk of poor prognosis in critically ill patients;The data showed that the levels of several indicators in patients with poor prognosis were statistically different with these in patients with better prognosis.In addition,the proportion of coma,diffuse intravascular coagulation and heart failure in patients with poor prognosis was significantly higher than that in patients with improved prognosis.Differentiated prevention and treatment strategies should be developed for severe patients with possible poor prognosis.