C反应蛋白与白蛋白比值对发热伴血小板减少综合征患者的预后意义

Prognostic Significance of the C-Reactive Protein to Albumin Ratio in Patients with Fever with Thrombocytopenia Syndrome

摘要: 目的：我们的研究是为了探索影响发热伴血小板减少综合征(SFTS)预后不良的危险因素，并探讨以炎症为基础的比值指标在SFTS患者中的预测意义。方法：回顾性收集2019年6月至2023年4月从安徽医科大学附属巢湖医院共纳入了152例SFTS病毒RNA阳性的确诊患者。根据患者治疗后是否存活将患者分为两组，生存组124例和死亡组28例。收集患者刚入院时第一次的采血数据，利用多因素logistic回归分析SFTS患者进展至死亡的独立危险因素。采用ROC曲线分析来评估NLR、CAR在识别SFTS患者预后不良的预测准确性。结果：多因素logistic回归分析发现年龄大、有出血表现、APTT延长和CAR是影响SFTS患者预后的危险因素，ROC曲线分析表明：CAR的AUC为0.770 (95%CI: 0.689~0.851; P < 0.001)。CAR的最佳截断值断值是0.1，灵敏性和特异性分别为82.1%和65.5%。结论：年龄大、有出血症状、APTT延长以及CAR高水平是SFTS患者死亡的重要危险因素，而较高的CAR可能会对预测SFTS患者的疾病进展与临床预后有一定的参考价值。

Abstract: Objective: Our study was intended to investigate the risk factors contributing to the poor prognosis of patients with fever with thrombocytopenia syndrome (SFTS) and the predictive value of inflam-mation-based ratio indicators in these patients. Methods: A total of 152 confirmed patients with positive SFTS virus RNA were retrospectively collected from June 2019 to April 2023 from Chaohu Hospital, Anhui Medical University. Patients were divided into two groups according to whether they survived after treatment, 124 in the survival group and 28 in the death group. Data from the first blood collection when the patients were first admitted to the hospital were collected, and in-dependent risk factors for progression to death in SFTS patients were analyzed using multivariate logistic regression. ROC curve analysis was used to assess the predictive accuracy of NLR, CAR in identifying SFTS patients with poor prognosis. Results: Multivariate logistic regression analysis identified older age, presence of bleeding manifestations, prolonged APTT and CAR as risk factors affecting the prognosis of SFTS patients, and ROC curve analysis showed that the AUC for CAR was 0.770 (95%CI: 0.689~0.851; P < 0.001). The optimal cut-off value for CAR was 0.1, with a sensitivity and specificity of 82.1% and 65.5%, respectively. Conclusion: Older age, presence of bleeding symptoms, prolonged APTT, and high levels of CAR are important risk factors for death in SFTS pa-tients, and higher CAR may be informative in predicting disease progression and clinical prognosis in SFTS patients.