Guangjie Wang,1,* Puhui Liu,2,* Hui Xie,2 Chuanzhen Niu,2 Jie Lyu,1 Youzhong An,1 Huiying Zhao1 

1Department of Critical Care Medicine, Peking University People’s Hospital, Beijing, People’s Republic of China; 2Department of Critical Care Medicine, Yantai Qishan Hospital, Yantai, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Huiying Zhao, Department of Critical Care Medicine, Peking University People’s Hospital, No. 11, Southern Xizhimen Road, Beijing, 100044, People’s Republic of China, Tel +86 13811088270, Email zhaohuiying@pkuph.edu.cn

Purpose: The high mortality rate associated with the critical stages of severe fever with thrombocytopenia syndrome (SFTS) does not have effective treatment. We aimed to evaluate the 28-day mortality and potential impact of glucocorticoid therapy in these patients.
Patients and Methods: This retrospective observational study included participants from the intensive care unit between July 2019 and April 2023. The participants were categorized into glucocorticoid (GC) and non-GC groups. Propensity score matching (PSM) was employed to ensure comparability between groups. We used Cox proportional hazard models to examine mortality risk associated with GC use, Kaplan–Meier survival analyses for overall survival, stratified Cox proportional hazard models for subgroup analyses, and likelihood ratio tests to examine interactions between subgroups.
Results: Of 218 patients with SFTS (median age, 71 years; male, 49.1%), 61.9% required mechanical ventilation, 58.3% received GC treatment, and the 28-day mortality rate was 61.5%. After PSM, there were 58 patients in each group; post-PSM analysis revealed improved 28-day mortality rates with GC treatment, particularly for patients with Glasgow coma scale (GCS) score < 13 (hazard ratio [HR], 95% confidence interval [CI] for GCS score: 9– 12: 0.39, 0.17– 0.88, p=0.024 and for GCS score: 3– 8: 0.09, 0.02– 0.35, p=0.001); lactate levels > 2 mmol/L (0.35, 0.15– 0.83, p=0.017); and norepinephrine usage (0.26, 0.13– 0.49, p< 0.001). Combining antiviral (0.41, 0.22– 0.78, p=0.006) or immunoglobulin therapy (0.22, 0.1– 0.51, p< 0.001) with GC treatment significantly decreased the 28-day mortality rates, compared with GC monotherapy.
Conclusion: Using GCs reduced the high 28-day mortality rate in the patients, especially with low GCS score, high lactate levels, norepinephrine intake, and on antiviral or immunoglobulin therapy.

Keywords: glucocorticoids, mortality, severe fever with thrombocytopenia syndrome, intensive care unit, virus infection