Sook In Jung1, Ye Eun Kim2, Na Ra Yun3, Choon-Mee Kim4, Dong-Min Kim3, Mi Ah Han4, Uh Jin Kim1, Seong Eun Kim1, Jieun Kim5, Seong Yeol Ryu6, Hyun Ah Kim6, Jian Hur7, Young Keun Kim8, Hye Won Jeong9, Jung Yeon Heo10, Dong Sik Jung11, Hyungdon Lee12, Kyungmin Huh13, Yee Gyung Kwak14, Sujin Lee15, Seungjin Lim15, Sun Hee Lee16, Sun Hee Park17, Joon-Sup Yeom18, Shin-Woo Kim19, In-Gyu Bae20, Juhyung Lee21, Eu Suk Kim22, Jun-Won Seo3. 1. Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea. 2. Department of Nursing, College of Medicine, Chosun University, Gwangju, Republic of Korea. 3. Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea. 4. Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea. 5. Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea. 6. Division of Infectious Diseases, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea. 7. Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea. 8. Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea. 9. Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea. 10. Department of Infectious Diseases, School of Medicine, Ajou University, Suwon, Republic of Korea. 11. Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Republic of Korea. 12. Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon, Republic of Korea. 13. Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Seoul, Republic of Korea. 14. Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea. 15. Department of Internal Medicine, College of Medicine, Pusan National University, Yangsan, Republic of Korea. 16. Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea. 17. Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea. 18. Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea. 19. Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. 20. Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea. 21. Department of Preventive Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea. 22. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Abstract
BACKGROUND: Severe fever with thrombocytopenia syndrome (SFTS) is an acute, febrile, and potentially fatal tick-borne disease caused by the SFTS Phlebovirus. Here, we evaluated the effects of steroid therapy in Korean patients with SFTS. METHODS: A retrospective study was performed in a multicenter SFTS clinical cohort from 13 Korean university hospitals between 2013 and 2017. We performed survival analysis using propensity score matching of 142 patients with SFTS diagnosed by genetic or antibody tests. RESULTS: Overall fatality rate was 23.2%, with 39.7% among 58 patients who underwent steroid therapy. Complications were observed in 37/58 (63.8%) and 25/83 (30.1%) patients in the steroid and non-steroid groups, respectively (P < .001). Survival analysis after propensity score matching showed a significant difference in mean 30-day survival time between the non-steroid and steroid groups in patients with a mild condition [Acute Physiology and Chronic Health Evaluation II (APACHE II) score <14; 29.2 (95% CI 27.70-30.73] vs. 24.9 (95% CI 21.21-28.53], P = .022]. Survival times for the early steroid (≤5 days from the start of therapy after symptom onset), late steroid (>5 days), and non-steroid groups, were 18.4, 22.4, and 27.3 days, respectively (P = .005). CONCLUSIONS: After steroid therapy, an increase in complications was observed among patients with SFTS. Steroid therapy should be used with caution, considering the possible negative effects of steroid therapy within 5 days of symptom onset or in patients with mild disease (APACHE II score <14).
BACKGROUND: Severe fever with thrombocytopenia syndrome (SFTS) is an acute, febrile, and potentially fatal tick-borne disease caused by the SFTS Phlebovirus. Here, we evaluated the effects of steroid therapy in Koreanpatients with SFTS. METHODS: A retrospective study was performed in a multicenter SFTS clinical cohort from 13 Korean university hospitals between 2013 and 2017. We performed survival analysis using propensity score matching of 142 patients with SFTS diagnosed by genetic or antibody tests. RESULTS: Overall fatality rate was 23.2%, with 39.7% among 58 patients who underwent steroid therapy. Complications were observed in 37/58 (63.8%) and 25/83 (30.1%) patients in the steroid and non-steroid groups, respectively (P < .001). Survival analysis after propensity score matching showed a significant difference in mean 30-day survival time between the non-steroid and steroid groups in patients with a mild condition [Acute Physiology and Chronic Health Evaluation II (APACHE II) score <14; 29.2 (95% CI 27.70-30.73] vs. 24.9 (95% CI 21.21-28.53], P = .022]. Survival times for the early steroid (≤5 days from the start of therapy after symptom onset), late steroid (>5 days), and non-steroid groups, were 18.4, 22.4, and 27.3 days, respectively (P = .005). CONCLUSIONS: After steroid therapy, an increase in complications was observed among patients with SFTS. Steroid therapy should be used with caution, considering the possible negative effects of steroid therapy within 5 days of symptom onset or in patients with mild disease (APACHE II score <14).
Authors: Seung Won Kang; Huong Thi Thanh Doan; Se Eun Choe; Jin Hyeong Noh; Mi Sun Yoo; Kondreddy Eswar Reddy; Young Ha Kim; Chang Hee Kweon; Suk Chan Jung; Ki Yoon Chang Journal: Parasitol Int Date: 2013-03-14 Impact factor: 2.230
Authors: Nelson Lee; K C Allen Chan; David S Hui; Enders K O Ng; Alan Wu; Rossa W K Chiu; Vincent W S Wong; Paul K S Chan; K T Wong; Eric Wong; C S Cockram; John S Tam; Joseph J Y Sung; Y M Dennis Lo Journal: J Clin Virol Date: 2004-12 Impact factor: 3.168