Low, moderate glucocorticoid doses beneficial in severe fever with thrombocytopenia syndrome

Treatment with low-to-moderate doses of glucocorticoids appears to help reduce case fatality rate among severe fever with thrombocytopenia syndrome (SFTS) patients with severe disease, as shown in a retrospective study.

Researchers reviewed the medical records of 2,478 eligible patients (median age 63 years, 43.2 percent men) with SFTS who were treated at designated hospitals. Clinical outcome was evaluated in terms of case fatality rate and clinical recovery.

A total of 331 patients (13.4 percent) received systemic glucocorticoids. Of these patients, 146 (44.1 percent) received hydrocortisone, 74 (22.4 percent) received methylprednisolone, and 56 (16.9 percent) received dexamethasone. Glucocorticoid therapy was initiated at a median of 1 day after hospital admission or a median of 7 days after disease onset. Therapy lasted for a median 5.0 days (median daily dose 63 mg methylprednisolone equivalent, median accumulated dose 340 mg).

An integrated parameter (L-index) based on Log10(LDH*BUN/LYM) was constructed to categorize disease severity. An L-index of >3.823 indicated severe SFTS, while an L-index of ≤3.823 indicated mild SFTS.

Multivariate logistic regression models showed that in the severe SFTS group, low-to-moderate glucocorticoid doses with ≤60 mg daily methylprednisolone or equivalent was associated with significantly reduced case fatality rate (odds ratio [OR], 0.46, 95 percent CI, 0.23–0.88). This benefit was not seen with high glucocorticoid doses.

In the mild SFTS group, on the other hand, glucocorticoid treatment appeared to contribute to significantly increased case fatality rate (OR, 3.34, 95 percent CI, 1.35–9.51), mainly driven by high-dose glucocorticoids (OR, 2.83, 95 percent CI, 1.72–4.96).

On further analysis, low-to-moderate glucocorticoid doses had a significant effect only in patients who were ≤65 years of age, male, and admitted within 7 days after onset.