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Clinical Score System to Differentiate Severe Fever with Thrombocytopenia Syndrome Patients from Patients with Scrub Typhus or Hemorrhagic Fever with Renal Syndrome in Korea

Journal of Korean Medical Science 2020년 35권 11호 p.77 ~ 77
 ( Heo Dae-Hyuk ) - Seoul National University Bundang Hospital Department of Internal Medicine

강유민 ( Kang Yu-Min ) - Kangwon National University School of Medicine Kangwon National University Hospital Department of Internal Medicine
송경호 ( Song Kyoung-Ho ) - Seoul National University Bundang Hospital Department of Internal Medicine
서준원 ( Seo Jun-Won ) - Seoul National University Bundang Hospital Department of Internal Medicine
김정한 ( Kim Jeong-Han ) - Seoul National University Bundang Hospital Department of Internal Medicine
전준영 ( Chun June-Young ) - Seoul National University Bundang Hospital Department of Internal Medicine
전강일 ( Jun Kang-Il ) - Seoul National University Hospital Department of Internal Medicine
강창경 ( Kang Chang-Kyung ) - Seoul National University College of Medicine Department of Internal Medicine
문송미 ( Moon Song-Mi ) - Seoul National University Bundang Hospital Department of Internal Medicine
최평균 ( Choe Pyoeng-Gyun ) - Seoul National University College of Medicine Department of Internal Medicine
박완범 ( Park Wan-Beom ) - Seoul National University College of Medicine Department of Internal Medicine
방지환 ( Bang Ji-Hwan ) - Seoul National University College of Medicine Department of Internal Medicine
김의석 ( Kim Eu-Suk ) - Seoul National University Bundang Hospital Department of Internal Medicine
김홍빈 ( Kim Hong-Bin ) - Seoul National University Bundang Hospital Department of Internal Medicine
박상원 ( Park Sang-Won ) - Seoul National University College of Medicine Department of Internal Medicine
오원섭 ( Oh Won-Sup ) - Kangwon National University School of Medicine Kangwon National University Hospital Department of Internal Medicine
김남중 ( Kim Nam-Joong ) - Seoul National University College of Medicine Department of Internal Medicine
오명돈 ( Oh Myoung-Don ) - Seoul National University College of Medicine Department of Internal Medicine

Abstract


Background: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with high mortality in East Asia. This study aimed to develop, for primary care providers, a prediction score using initial symptoms and basic laboratory blood tests to differentiate between SFTS and other endemic zoonoses in Korea.

Methods: Patients aged ≥ 18 years diagnosed with endemic zoonoses during a 3-year period (between January 2015 and December 2017) were retrospectively enrolled from 4 tertiary university hospitals. A prediction score was built based on multivariate logistic regression analyses.

Results: Of 84 patients, 35 with SFTS and 49 with other endemic zoonoses were enrolled. In multivariate logistic regression analysis, independent predictors of SFTS included neurologic symptoms (odds ratio [OR], 12.915; 95% confidence interval [CI], 2.173?76.747), diarrhea (OR, 10.306; 95% CI, 1.588?66.895), leukopenia (< 4,000/mm3) (OR, 19.400; 95% CI, 3.290?114.408), and normal C-reactive protein (< 0.5 mg/dL) (OR, 24.739; 95% CI, 1.812?337.742). We set up a prediction score by assigning one point to each of these four predictors. A score of ≥ 2 had 82.9% sensitivity (95% CI, 71.7%?87.5%) and 95.9% specificity (95% CI, 88.0%?99.2%). The area under the curve of the clinical prediction score was 0.950 (95% CI, 0.903?0.997).

Conclusion: This study finding suggests a simple and useful scoring system to predict SFTS in patients with endemic zoonoses. We expect this strategic approach to facilitate early differentiation of SFTS from other endemic zoonoses, especially by primary care providers, and to improve the clinical outcomes.

키워드

Severe Fever with Thrombocytopenia Syndrome; Prediction; Differential Diagnosis; Scrub Typhus; Hemorrhagic Fever with Renal Syndrome
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