CCM:严重发热伴血小板减少综合征患者心肌损伤相关生物标志物（肌钙蛋白I）水平升高与死亡率增加的相关性研究

OBJECTIVES: The objective of this study was to investigate the dynamic profiles of myocardial injury biomarkers and their association with mortality in patients with severe fever with thrombocytopenia syndrome (SFTS).本研究的目的是调查严重发热伴血小板减少综合征（SFTS）患者心肌损伤生物标志物的动态分布及其与死亡率的关联。

DESIGN: A retrospective cohort study.一项回顾性队列研究

SETTINGS: Union Hospital in Wuhan, China.中国武汉的联合医院

PATIENTS: A total of 580 patients with SFTS, observed between May 2014 and December 2021, were included in the final analysis.最终分析包括了2014年5月至2021年12月期间观察的580名SFTS患者

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: In total, 580 patients with SFTS were enrolled in the study, comprised of 469 survivors and 111 nonsurvivors, with a 21-day fatality rate of 19.1%. The elevation of troponin I (TnI) was observed in 61.6% patients (357/580) with SFTS upon admission, and 68.4% patients (397/580) de- veloped an abnormal TnI level during hospitalization. Multivariate logistic regression identified age, viral load, platelet count, creatinine level, and TnI level as potential risk factors for mortality in patients with SFTS. The results of restricted cubic splines revealed that when the TnI level (baseline TnI: 1.55 [lg (ng/L+1)], peak value: TnI 1.90 [lg (ng/L+1)]) exceeded a certain threshold, the predicted mortality of patients with SFTS increased alongside the rise in TnI levels. Mortality rate surpassed 40% among patients with SFTS with TnI greater than or equal to 10 times the upper limit of normal at admission (43.8%) or during hospitalization (41.7%). Older age, a his- tory of cardiovascular disease, and higher d-dimer levels were potential risk factors for elevated TnI levels in patients with SFTS.共有580名SFTS患者纳入研究，其中469名为存活者，111名为非存活者，21天死亡率为19.1%。在入院时，61.6%的患者（357/580）观察到肌钙蛋白I（TnI）水平升高，68.4%的患者（397/580）在住院期间发展出异常的TnI水平。多变量逻辑回归分析确定年龄、病毒载量、血小板计数、肌酐水平和TnI水平是SFTS患者死亡的潜在风险因素。限制性立方样条的结果表明，当TnI水平（基线TnI：1.55 [lg (ng/L+1)]，峰值：TnI 1.90 [lg (ng/L+1)]）超过某个阈值时，SFTS患者的预计死亡率随着TnI水平的升高而增加。入院时或住院期间TnI大于或等于正常上限10倍的SFTS患者死亡率超过40%（分别为43.8%和41.7%）。年龄较大的患者、心血管疾病史以及更高的D-二聚体水平是SFTS患者TnI水平升高的潜在风险因素。

CONCLUSIONS: Elevated TnI levels were prevalent among patients with SFTS and were strongly associated with an increased risk of mortality.SFTS患者中TnI水平升高较为普遍，并与增加的死亡风险强烈相关。