Both of coagulopathy and neutrophil extracellular trap markers are associated with poor prognosis of dabie bandavirus infection.

BACKGROUND

Severe fever with thrombocytopenia syndrome (SFTS), caused by Dabie bandavirus (DBV), has a high mortality. Coagulopathy and neutrophil extracellular traps (NETs) formation are implicated in disease progression, and their combined prognostic value remains unclear.

OBJECTIVES

To investigate the relationship between the levels and changes of coagulation and NETs markers in early admission of SFTS patients and their prognosis, as well as the differences between SFTS and Hemorrhagic fever with renal syndrome (HFRS) patients.

METHODS

A prospective cohort of 124 SFTS patients was analyzed. Coagulation parameters, NETs biomarker (Citrullinated histone H3, CitH3) and other routine laboratory parameters were measured on admission and day 3. During the same period, the coagulation and NETs indicators were measured in 13 HFRS patients on admission.

RESULTS

Multivariate analysis identified activated partial thromboplastin time (APTT) (OR: 1.051, p = 0.010), D-dimer (OR: 1.174, p = 0.044), and CitH3 (OR: 1.002, p = 0.020) as independent mortality predictors in SFTS patients. Optimal cut-offs stratified patients into risk groups, with triple-positive markers (APTT >60.8 s, D-dimer >4.96 μg/mL, CitH3 > 942 pg/mL) showing the highest mortality (p < 0.05). Survivors exhibited significant reductions in APTT and D-dimer by day 3. The SFTS patients had higher CitH3 level and 28-day mortality compared to the HFRS patients (p < 0.05).

CONCLUSION

Both coagulopathy and NETs markers are predictive of mortality in SFTS patients, dynamic monitoring of coagulation parameters in the early stage of admission has the potential to be used for prognostic evaluation and guiding treatment.