Corticosteroids May Have Negative Effects on the Management of Patients with Severe Fever with Thrombocytopenia Syndrome: A Case-Control Study

Abstract

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging viral hemorrhagic fever in China, Korea, and Japan. To date, no standardized treatment protocol for SFTS has been established. Corticosteroids (CS) may be administered to patients with SFTS and hemophagocytic syndrome, but its effectiveness and safety are still debatable. We conducted a retrospective case series review at four medical facilities in Miyazaki, Japan. Based on the medical records, clinical data, including the patients background, symptoms, physical findings, laboratory data at initial presentation, treatment, and outcome, were compared between the CS-treated and the non-CS-treated group. A total of 47 patients with confirmed SFTS in each hospital were enrolled in this study; there were 14 fatal cases and 33 nonfatal cases. The case fatality ratio was 29.8%. After adjusting patients' background by propensity score matching, the case fatality ratio was higher (p = 0.04) and complications of secondary infections, including invasive pulmonary aspergillosis, tended to be more frequent (p = 0.07) in the CS-treated group than in the non-CS-treated group. These data suggested that administration of CS to patients with SFTS should be carefully considered.

Keywords: corticosteroid; prognostic factor; severe fever with thrombocytopenia syndrome; viral hemorrhagic fever.

Figure 1

Kaplan–Meier curves for survival in the patients with severe fever with thrombocytopenia syndrome. (A) Survival curves in the corticosteroid-treated and the non-corticosteroid-treated groups (p = 0.02 by log-rank test). (B) Survival curves in the corticosteroid-treated and the non-corticosteroid-treated groups after propensity score matching (p = 0.10 by log-rank test).

Figure 1

Kaplan–Meier curves for survival in the patients with severe fever with thrombocytopenia syndrome. (A) Survival curves in the corticosteroid-treated and the non-corticosteroid-treated groups (p = 0.02 by log-rank test). (B) Survival curves in the corticosteroid-treated and the non-corticosteroid-treated groups after propensity score matching (p = 0.10 by log-rank test).