Prognostic value of procalcitonin to platelet ratio in patients with fever with thrombocytopenia syndrome

doi:10.3969/j.issn.1004-583X.2023.04.010

Abstract

Abstract:

Objective To investigate the value of procalcitonin/platelet ratio(PCT/PLT) in evaluating the prognosis of Severe fever with thrombocytopenia syndrome(SFTS). Methods A total of 156 SFTS patients diagnosed in Weihai Central Hospital from January 1, 2020 to January 1, 2022 were collected andassigned into death group and survival group according to the prognosis. the basic data and laboratory indicators of the two groups were compared, the independent risk factors affecting the prognosis of SFTS were screened by univariate and binomial multiple Logistic regression, and the value of different influencing factors on the prognosis of SFTS was evaluated by the area under the receiver operating characteristic(ROC) curve, sensitivity, specificity, accuracy.Results Activated partial thromboplastin time, thrombin time, D-dimer, alanine aminotransferase, serum creatinine, lactate dehydrogenase, aspartate aminotransferase, blood urea nitrogen, activated partial thromboplastin time/platelet, neutrophil count, neutrophil lymphocyte ratio, creatine kinase isoenzyme, procalcitonin, PCT/PLT, as well as the proportion of patients whose nucleic acid quantity were higher than the optimal reference value in the death group was significantly higher than those in the survival group(P<0.05). The proportion of patients with Ca²⁺, PLT, lymphocyte count higher than the optimal reference value was significantly lower than that in the survival group(P<0.05). Univariate and binomial multiple Logistic regression showed that age, thrombin time, aspartate aminotransferase, lymphocyte count, PCT/PLT, and viral nucleic acid quantification were independent risk factors for the prognosis of SFTS. The best reference value of PCT/PLT was 0.005, and the AUC was 0.828(0.757-0.898). When PCT/PLT was greater than 0.005, the risk of death was increased by 30 times, the sensitivity was 87.1%, and the specificity was 78.4%. Conclusion PCT/PLT can be used as a clinical indicator to evaluate the prognosis of patients with SFTS.

Key words: severe fever with thrombocytopenia syndrome, phlebotomus virus, procalcitonin, platelets, death, prognosis

CLC Number:

R558.2

Yang Jinqiang, Zhang Renmin. Prognostic value of procalcitonin to platelet ratio in patients with fever with thrombocytopenia syndrome[J]. Clinical Focus, 2023, 38(4): 346-351.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.04.010

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I4/346

Figures/Tables 5

References 18

[1]	Seo JW, Kim D, Yun N, et al. Clinical update of severe fever with thrombocytopenia syndrome. viruses[J]. Viruses, 2021, 13(7):1213. doi: 10.3390/v13071213 URL
[2]	He F, Zheng X, Zhang Z. Clinical features of severe fever with thrombocytopenia syndrome and analysis of risk factors for mortality[J]. BMC Infect Dis, 2021, 21(1): 1253. doi: 10.1186/s12879-021-06946-3 pmid: 34906106
[3]	Wei Y, Wang Z, Kang L, et al. NLR, a convenient early-warning biomarker of fatal outcome in patients with severe fever with thrombocytopenia syndrome[J]. Front Microbiol, 2022, 13: 907888. doi: 10.3389/fmicb.2022.907888 URL
[4]	Liu Z, Zhang R, Zhou W, et al. High levels of C-reactive protein-to-albumin ratio(CAR) are associated with a poor prognosis in patients with severe fever with thrombocytopenia syndrome in early stage[J]. J Med Virol, 2022, 94(11):5375-5384. doi: 10.1002/jmv.v94.11 URL
[5]	Wang Y, Song Z, Wei X, et al. Clinical laboratory parameters and fatality of Severe fever with thrombocytopenia syndrome patients: A systematic review and meta-analysis[J]. PLoS Negl Trop Dis, 2022, 16(6): e0010489.
[6]	Liu Y, Ni J, Xiong Y, et al. Neutrophil-to-lymphocyte ratio is associated with 28-day mortality in patients with severe fever with thrombocytopenia syndrome[J]. BMC Infect Dis, 2022, 22(1): 225. doi: 10.1186/s12879-022-07206-8 pmid: 35249544
[7]	中华人民共和国卫生部. 发热伴血小板减少综合征防治指南(2010版)[J]. 中华临床感染病杂志, 2011, 4(4):193-194.
[8]	Jiang X, Wang Y, Zhang X, et al. Factors associated with severe fever with thrombocytopenia syndrome in endemic areas of China[J]. Front Public Health, 2022, 10: 844220. doi: 10.3389/fpubh.2022.844220 URL
[9]	彭真, 尚佳. 发热伴血小板减少综合征流行现状及诊疗新进展[J]. 临床内科杂志, 2022, 39(4):223-226.
[10]	李佳宸, 王玉娜, 赵静, 等. 发热伴血小板减少综合征流行病学研究进展[J]. 中华流行病学杂志, 2021, 42(12):2226-2233.
[11]	张清, 杜娜, 车丽赫, 等. 吉林省首例发热伴血小板减少综合征[J]. 中华传染病杂志, 2021, 39(7):442-443.
[12]	王敬忠, 陈宏标, 彭志强, 等. 广东省首例输入性发热伴血小板减少综合征病例调查[J]. 中国感染控制杂志, 2021, 20(1):85-89.
[13]	Wang D, Cao K, Shen X, et al. Clinical characteristics and immune status of patients with severe fever with thrombocytopenia syndrome[J]. Viral Immunol, 2022.
[14]	Wang T, Xu L, Zhu B, et al. Immune escape mechanisms of severe fever with thrombocytopenia syndrome virus[J]. Front Immunol, 2022, 13: 937684. doi: 10.3389/fimmu.2022.937684 URL
[15]	吴熙, 于学忠. 降钙素原[J]. 中国医学科学院学报, 2008, 30(2):231-235.
[16]	张金辉, 田敏. 病毒感染和细菌感染中降钙素原(PCT)和超敏C-反应蛋白(hs-CRP)的诊断价值分析[J]. 世界最新医学信息文摘, 2015, 15(44):5-6.
[17]	罗豫川, 董明林, 胡卫华, 等. D-二聚体、C-反应蛋白、降钙素原及血常规对重型新型冠状病毒肺炎患者预后评估的临床意义[J]. 武汉大学学报(医学版), 2021, 42(2):233-236.
[18]	王博昊, 易志杰, 黄雨馨, 等. 发热伴血小板减少综合征患者病情严重程度关联因素分析[J]. 郑州大学学报(医学版), 2021, 56(5):640-644.

项目	存活组(n=125)	死亡组(n=31)	P值	Z值/χ²值
年龄[Q2(Q1, Q3)]	66.00(61.00, 71.00)	71.00(66.50, 78.00)	0.001	3.302
性别[例(%)]
男女	58(46.4) 67(53.6)	15(48.4) 16(51.6)	0.843	0.039
APTT[例(%)]
≤43.4 s >43.4 s	107(85.6) 18(14.4)	14(45.2) 17(54.8)	0.001	23.343
TT[例(%)]
≤19.4 s >19.4 s	75(60.0) 50(40.0)	7(22.6) 24(77.4)	0.001	13.949
DD[例(%)]
≤1.89 mg/L >1.89 mg/L	79(63.2) 46(36.8)	10(32.3) 21(67.7)	0.002	9.706
ALT[例(%)]
≤107 U/L >107 U/L	92(73.6) 33(26.4)	14(45.2) 17(54.8)	0.002	9.224
SCR[例(%)]
≤95 μmol/L >95 μmol/L	110(88.0) 15(12.0)	17(54.8) 14(45.2)	0.001	18.049
LDH[例(%)]
≤1282 U/L >1282 U/L	102(81.6) 23(18.4)	11(35.5) 20(64.5)	0.001	26.458
AST[例(%)]
≤326 U/L >326 U/L	99(79.2) 26(20.8)	13(41.9) 18(58.1)	0.001	17.034
BUN[例(%)]
≤6.8 mmol/L >6.8 mmol/L	81(64.8) 44(35.2)	7(22.6) 24(77.4)	0.001	18.006
Ca²⁺[例(%)]
≤1.91 mmol/L >1.91 mmol/L	46(36.8) 79(63.2)	20(64.5) 11(35.5)	0.005	7.818
WBC[例(%)]
≤2.91×10⁹/L >2.91×10⁹/L	82(65.6) 43(34.4)	24(80.0) 6(20.0)	0.128	2.321
PLT[例(%)]
≤60×10⁹/L >60×10⁹/L	57(45.6) 68(54.4)	26(83.9) 5(16.1)	0.001	14.613
APTT/PLT[例(%)]
≤0.7 >0.7	78(62.4) 47(37.6)	5(16.1) 26(83.9)	0.001	21.361
NC[例(%)]
≤0.66×10⁹/L >0.66×10⁹/L	28(22.4) 97(77.6)	0(0) 31(100.0)	0.004	8.463
LC[例(%)]
≤0.44×10⁹/L >0.44×10⁹/L	47(37.6) 78(62.4)	18(58.1) 13(41.9)	0.039	4.280
NLR[例(%)]
≤1.35 >1.35	30(24.0) 95(76.0)	1(3.2) 30(96.8)	0.009	6.732
PLR[例(%)]
≤152.4 >152.4	74(59.2) 51(40.8)	23(74.2) 8(25.8)	0.123	2.375
CK-MB[例(%)]
≤23.1 U/L >23.1 U/L	65(52.0) 60(48.0)	6(19.4) 25(80.6)	0.001	10.675
PCT[例(%)]
≤0.25 ng/ml >0.25 ng/ml	93(74.4) 32(25.6)	7(22.6) 24(77.4)	0.001	28.986
PCT/PLT[例(%)]
≤0.005 >0.005	98(78.4) 27(21.6)	4(12.9) 27(87.1)	0.001	47.081
病毒核酸定量[例(%)]
≤12 000 >12 000	110(88.0) 15(12.0)	6(19.4) 25(80.6)	0.001	46.317
发热[例(%)]
否是	22(17.6) 103(82.4)	11(35.5) 20(64.5)	0.129	4.763
咳嗽[例(%)]
否是	113(90.4) 12(9.6)	30(96.8) 1(3.2)	0.467	0.263
消化道症状[例(%)]
否是	74(59.2) 51(40.8)	17(54.8) 14(45.2)	0.659	0.194
周身乏力[例(%)]
否是	34(27.2) 91(72.8)	10(32.3) 21(67.7)	0.575	0.314

项目	存活组(n=125)	死亡组(n=31)	P值	Z值/χ²值
年龄[Q2(Q1, Q3)]	66.00(61.00, 71.00)	71.00(66.50, 78.00)	0.001	3.302
性别[例(%)]
男女	58(46.4) 67(53.6)	15(48.4) 16(51.6)	0.843	0.039
APTT[例(%)]
≤43.4 s >43.4 s	107(85.6) 18(14.4)	14(45.2) 17(54.8)	0.001	23.343
TT[例(%)]
≤19.4 s >19.4 s	75(60.0) 50(40.0)	7(22.6) 24(77.4)	0.001	13.949
DD[例(%)]
≤1.89 mg/L >1.89 mg/L	79(63.2) 46(36.8)	10(32.3) 21(67.7)	0.002	9.706
ALT[例(%)]
≤107 U/L >107 U/L	92(73.6) 33(26.4)	14(45.2) 17(54.8)	0.002	9.224
SCR[例(%)]
≤95 μmol/L >95 μmol/L	110(88.0) 15(12.0)	17(54.8) 14(45.2)	0.001	18.049
LDH[例(%)]
≤1282 U/L >1282 U/L	102(81.6) 23(18.4)	11(35.5) 20(64.5)	0.001	26.458
AST[例(%)]
≤326 U/L >326 U/L	99(79.2) 26(20.8)	13(41.9) 18(58.1)	0.001	17.034
BUN[例(%)]
≤6.8 mmol/L >6.8 mmol/L	81(64.8) 44(35.2)	7(22.6) 24(77.4)	0.001	18.006
Ca²⁺[例(%)]
≤1.91 mmol/L >1.91 mmol/L	46(36.8) 79(63.2)	20(64.5) 11(35.5)	0.005	7.818
WBC[例(%)]
≤2.91×10⁹/L >2.91×10⁹/L	82(65.6) 43(34.4)	24(80.0) 6(20.0)	0.128	2.321
PLT[例(%)]
≤60×10⁹/L >60×10⁹/L	57(45.6) 68(54.4)	26(83.9) 5(16.1)	0.001	14.613
APTT/PLT[例(%)]
≤0.7 >0.7	78(62.4) 47(37.6)	5(16.1) 26(83.9)	0.001	21.361
NC[例(%)]
≤0.66×10⁹/L >0.66×10⁹/L	28(22.4) 97(77.6)	0(0) 31(100.0)	0.004	8.463
LC[例(%)]
≤0.44×10⁹/L >0.44×10⁹/L	47(37.6) 78(62.4)	18(58.1) 13(41.9)	0.039	4.280
NLR[例(%)]
≤1.35 >1.35	30(24.0) 95(76.0)	1(3.2) 30(96.8)	0.009	6.732
PLR[例(%)]
≤152.4 >152.4	74(59.2) 51(40.8)	23(74.2) 8(25.8)	0.123	2.375
CK-MB[例(%)]
≤23.1 U/L >23.1 U/L	65(52.0) 60(48.0)	6(19.4) 25(80.6)	0.001	10.675
PCT[例(%)]
≤0.25 ng/ml >0.25 ng/ml	93(74.4) 32(25.6)	7(22.6) 24(77.4)	0.001	28.986
PCT/PLT[例(%)]
≤0.005 >0.005	98(78.4) 27(21.6)	4(12.9) 27(87.1)	0.001	47.081
病毒核酸定量[例(%)]
≤12 000 >12 000	110(88.0) 15(12.0)	6(19.4) 25(80.6)	0.001	46.317
发热[例(%)]
否是	22(17.6) 103(82.4)	11(35.5) 20(64.5)	0.129	4.763
咳嗽[例(%)]
否是	113(90.4) 12(9.6)	30(96.8) 1(3.2)	0.467	0.263
消化道症状[例(%)]
否是	74(59.2) 51(40.8)	17(54.8) 14(45.2)	0.659	0.194
周身乏力[例(%)]
否是	34(27.2) 91(72.8)	10(32.3) 21(67.7)	0.575	0.314

项目	回归系数	标准误	Z值	Wald χ²值	OR值	P值	95%CI
项目	回归系数	标准误	Z值	Wald χ²值	OR值	P值	下限	上限
年龄	0.084	0.026	3.247	10.543	1.088	0.001	1.034	1.145
APTT(>43.4 s)	-1.977	0.442	4.474	20.020	7.218	0.001	3.037	17.158
TT(>19.4 s)	1.638	0.467	3.509	12.310	5.143	0.001	2.060	12.838
DD(>1.89 mg/L)	1.283	0.427	3.007	9.040	3.607	0.003	1.563	8.322
ALT(>107 U/L)	1.219	0.414	2.945	8.675	3.385	0.003	1.504	7.621
SCR(>95 μmol/L)	1.798	0.454	3.962	15.697	6.039	0.001	2.481	14.701
LDH(>1282 U/L)	2.087	0.441	4.737	22.439	8.063	0.001	3.400	19.125
AST(>326 U/L)	1.662	0.425	3.907	15.266	5.272	0.001	2.290	12.139
BUN(>6.8 mmol/L)	1.842	0.469	3.932	15.458	6.312	0.001	2.519	15.814
Ca²⁺(≤1.91 mmol/L)	-1.139	0.419	-2.720	7.396	0.320	0.007	0.141	0.728
PLT(≤60×10⁹/L)	-1.825	0.520	-3.508	12.305	0.161	0.001	0.058	0.447
APTT/PLT(>0.7)	2.155	0.522	4.128	17.042	8.630	0.001	3.102	24.010
LC(≤0.44×10⁹/L)	-0.832	0.408	-2.038	4.155	0.435	0.042	0.196	0.968
NLR(>1.35)	2.249	1.038	2.166	4.694	9.474	0.030	1.239	72.440
CK-MB(>23.1 U/L)	1.507	0.489	3.085	9.516	4.514	0.002	1.732	11.761
PCT(>0.25 ng/ml)	2.299	0.476	4.830	23.333	9.964	0.001	3.920	25.327
PCT/PLT(>0.005)	3.199	0.578	5.532	30.608	18.500	0.001	7.889	50.087
病毒核酸定量(>12 000)	3.420	0.531	6.435	41.405	20.556	0.001	10.783	64.586

项目	回归系数	标准误	Z值	Wald χ²值	OR值	P值	95%CI
项目	回归系数	标准误	Z值	Wald χ²值	OR值	P值	下限	上限
年龄	0.084	0.026	3.247	10.543	1.088	0.001	1.034	1.145
APTT(>43.4 s)	-1.977	0.442	4.474	20.020	7.218	0.001	3.037	17.158
TT(>19.4 s)	1.638	0.467	3.509	12.310	5.143	0.001	2.060	12.838
DD(>1.89 mg/L)	1.283	0.427	3.007	9.040	3.607	0.003	1.563	8.322
ALT(>107 U/L)	1.219	0.414	2.945	8.675	3.385	0.003	1.504	7.621
SCR(>95 μmol/L)	1.798	0.454	3.962	15.697	6.039	0.001	2.481	14.701
LDH(>1282 U/L)	2.087	0.441	4.737	22.439	8.063	0.001	3.400	19.125
AST(>326 U/L)	1.662	0.425	3.907	15.266	5.272	0.001	2.290	12.139
BUN(>6.8 mmol/L)	1.842	0.469	3.932	15.458	6.312	0.001	2.519	15.814
Ca²⁺(≤1.91 mmol/L)	-1.139	0.419	-2.720	7.396	0.320	0.007	0.141	0.728
PLT(≤60×10⁹/L)	-1.825	0.520	-3.508	12.305	0.161	0.001	0.058	0.447
APTT/PLT(>0.7)	2.155	0.522	4.128	17.042	8.630	0.001	3.102	24.010
LC(≤0.44×10⁹/L)	-0.832	0.408	-2.038	4.155	0.435	0.042	0.196	0.968
NLR(>1.35)	2.249	1.038	2.166	4.694	9.474	0.030	1.239	72.440
CK-MB(>23.1 U/L)	1.507	0.489	3.085	9.516	4.514	0.002	1.732	11.761
PCT(>0.25 ng/ml)	2.299	0.476	4.830	23.333	9.964	0.001	3.920	25.327
PCT/PLT(>0.005)	3.199	0.578	5.532	30.608	18.500	0.001	7.889	50.087
病毒核酸定量(>12 000)	3.420	0.531	6.435	41.405	20.556	0.001	10.783	64.586

项目	回归系数	标准误	Z值	Wald χ²值	OR值	P值	95%CI
项目	回归系数	标准误	Z值	Wald χ²值	OR值	P值	下限	上限
年龄	0.127	0.054	2.329	5.425	1.135	0.020	1.020	1.263
TT(>19.4 s)	2.574	1.297	1.985	3.941	13.121	0.047	1.033	166.649
AST(>326 U/L)	2.676	1.221	2.192	4.803	14.527	0.028	1.327	159.061
LC(≤0.44×109/L)	-2.616	1.098	-2.381	5.671	0.073	0.017	0.008	0.630
PCT/PLT(>0.005)	3.769	1.154	3.266	10.664	30.327	0.001	4.512	416.055
病毒核酸定量(>12 000)	3.940	1.016	3.878	15.041	38.407	0	7.019	376.477