Impact of Glucocorticoid Therapy on 28-Day Mortality in Patients Having Severe Fever with Thrombocytopenia Syndrome in an Intensive Care Unit: A Retrospective Analysis.

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.