Case-Fatality ratio and effectiveness of ribavirin therapy among hospitalized patients in china who had severe fever with thrombocytopenia syndrome

Wei Liu, Qing Bin Lu, Ning Cui, Hao Li, Li Yuan Wang, Kun Liu, Zhen Dong Yang, Bing Jun Wang, Hong Yu Wang, Yao Yun Zhang, Lu Zhuang, Chun Yan Hu, Chun Yuan, Xue Juan Fan, Zhen Wang, Lan Zhang, Xiao Ai Zhang, David Walker, Wu Chun Cao

Research output: Contribution to journalArticle

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Abstract

Background. The wide distribution and high case-fatality ratio of severe fever with thrombocytopenia syndrome (SFTS) have made it a significant public health problem. This study was designed to identify the predictors of fatal outcomes and to evaluate the effectiveness of antiviral therapy in treating SFTS virus (SFTSV)-infected patients.Methods. A cross-sectional study was performed in a general hospital located in Xinyang city, whereas the largest number of patients with SFTS in China were treated during 2011-2012. The primary outcome for the treatment effect analysis was death. Other outcomes included sequential platelet levels and viral loads observed throughout the hospitalization and the interval between the initiation of ribavirin therapy and the return of the platelet count to a normal level.Results. A total of 311 SFTSV-infected patients were included in the study. The most frequent clinical presentations were fever, weakness, myalgia, and gastrointestinal symptoms. Each patient had thrombocytopenia, leukopenia, or both. The case-fatality ratio (CFR) was 17.4% (95% confidence interval [CI], 13.1%-21.6%). Older age (odds ratio [OR], 1.061; 95% CI, 1.023-1.099; P =. 001), decreased level of consciousness (OR, 5.397; 95% CI, 2.660-10.948; P <. 001), and elevated levels of lactate dehydrogenase (>1200 U/L; OR, 2.620; 95% CI, 1.073-6.399; P =. 035) and creatine kinase (>800 U/L; OR, 2.328; 95% CI, 1.129-4.800; P =. 022) were significantly associated with fatal outcome. The CFRs were similar between patients who received ribavirin and those who did not. Ribavirin treatment showed no significant effect on either platelet counts or viral loads during hospitalization of patients with fatal or nonfatal cases.Conclusions. These findings can improve knowledge about the characteristics of patients with fatal outcomes and the use of antiviral drug for SFTS.

Original languageEnglish (US)
Pages (from-to)1292-1299
Number of pages8
JournalClinical Infectious Diseases
Volume57
Issue number9
DOIs
StatePublished - Nov 1 2013

Fingerprint

Ribavirin
Thrombocytopenia
China
Fever
Fatal Outcome
Confidence Intervals
Odds Ratio
Viral Load
Platelet Count
Therapeutics
Antiviral Agents
Hospitalization
Viruses
Myalgia
Leukopenia
Creatine Kinase
Consciousness
General Hospitals
Blood Platelets
Public Health

Keywords

  • case-fatality
  • ribavirin therapy
  • severe fever with thrombocytopenia syndrome

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

Case-Fatality ratio and effectiveness of ribavirin therapy among hospitalized patients in china who had severe fever with thrombocytopenia syndrome. / Liu, Wei; Lu, Qing Bin; Cui, Ning; Li, Hao; Wang, Li Yuan; Liu, Kun; Yang, Zhen Dong; Wang, Bing Jun; Wang, Hong Yu; Zhang, Yao Yun; Zhuang, Lu; Hu, Chun Yan; Yuan, Chun; Fan, Xue Juan; Wang, Zhen; Zhang, Lan; Zhang, Xiao Ai; Walker, David; Cao, Wu Chun.

In: Clinical Infectious Diseases, Vol. 57, No. 9, 01.11.2013, p. 1292-1299.

Research output: Contribution to journalArticle

Liu, W, Lu, QB, Cui, N, Li, H, Wang, LY, Liu, K, Yang, ZD, Wang, BJ, Wang, HY, Zhang, YY, Zhuang, L, Hu, CY, Yuan, C, Fan, XJ, Wang, Z, Zhang, L, Zhang, XA, Walker, D & Cao, WC 2013, 'Case-Fatality ratio and effectiveness of ribavirin therapy among hospitalized patients in china who had severe fever with thrombocytopenia syndrome', Clinical Infectious Diseases, vol. 57, no. 9, pp. 1292-1299. https://doi.org/10.1093/cid/cit530
Liu, Wei ; Lu, Qing Bin ; Cui, Ning ; Li, Hao ; Wang, Li Yuan ; Liu, Kun ; Yang, Zhen Dong ; Wang, Bing Jun ; Wang, Hong Yu ; Zhang, Yao Yun ; Zhuang, Lu ; Hu, Chun Yan ; Yuan, Chun ; Fan, Xue Juan ; Wang, Zhen ; Zhang, Lan ; Zhang, Xiao Ai ; Walker, David ; Cao, Wu Chun. / Case-Fatality ratio and effectiveness of ribavirin therapy among hospitalized patients in china who had severe fever with thrombocytopenia syndrome. In: Clinical Infectious Diseases. 2013 ; Vol. 57, No. 9. pp. 1292-1299.
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AU - Lu, Qing Bin

AU - Cui, Ning

AU - Li, Hao

AU - Wang, Li Yuan

AU - Liu, Kun

AU - Yang, Zhen Dong

AU - Wang, Bing Jun

AU - Wang, Hong Yu

AU - Zhang, Yao Yun

AU - Zhuang, Lu

AU - Hu, Chun Yan

AU - Yuan, Chun

AU - Fan, Xue Juan

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AU - Walker, David

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N2 - Background. The wide distribution and high case-fatality ratio of severe fever with thrombocytopenia syndrome (SFTS) have made it a significant public health problem. This study was designed to identify the predictors of fatal outcomes and to evaluate the effectiveness of antiviral therapy in treating SFTS virus (SFTSV)-infected patients.Methods. A cross-sectional study was performed in a general hospital located in Xinyang city, whereas the largest number of patients with SFTS in China were treated during 2011-2012. The primary outcome for the treatment effect analysis was death. Other outcomes included sequential platelet levels and viral loads observed throughout the hospitalization and the interval between the initiation of ribavirin therapy and the return of the platelet count to a normal level.Results. A total of 311 SFTSV-infected patients were included in the study. The most frequent clinical presentations were fever, weakness, myalgia, and gastrointestinal symptoms. Each patient had thrombocytopenia, leukopenia, or both. The case-fatality ratio (CFR) was 17.4% (95% confidence interval [CI], 13.1%-21.6%). Older age (odds ratio [OR], 1.061; 95% CI, 1.023-1.099; P =. 001), decreased level of consciousness (OR, 5.397; 95% CI, 2.660-10.948; P <. 001), and elevated levels of lactate dehydrogenase (>1200 U/L; OR, 2.620; 95% CI, 1.073-6.399; P =. 035) and creatine kinase (>800 U/L; OR, 2.328; 95% CI, 1.129-4.800; P =. 022) were significantly associated with fatal outcome. The CFRs were similar between patients who received ribavirin and those who did not. Ribavirin treatment showed no significant effect on either platelet counts or viral loads during hospitalization of patients with fatal or nonfatal cases.Conclusions. These findings can improve knowledge about the characteristics of patients with fatal outcomes and the use of antiviral drug for SFTS.

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