Evidence map›Paper›PMID 40193020›Full record

Observational studyEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2025

Additional biomarkers and emm types associated with group A streptococcal toxic shock syndrome: a Japanese nationwide observational study.

Shigeo Hanada, Takeaki Wajima, Misako Takata, Miyuki Morozumi, Yukio Sato, Junichi Sasaki, Satoshi Iwata, Kimiko Ubukata

Abstract readObservational StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Predominance of M1European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026
    Article
  2. Article
  3. [Research progress on toxic shock syndrome due to group AZhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics · 2026
    Review
  4. Case Report: FatalFrontiers in medicine · 2026
    Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Shigeo Hanada *Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. gourouhanada@yahoo.co.jp.
Takeaki WajimaDepartment of Microbiology, Faculty of Pharmacy, Meijo University, Nagoya, Japan.
Misako TakataDepartment of Microbiology, Tokyo Medical University, Tokyo, Japan.
Miyuki MorozumiDepartment of Microbiology, Tokyo Medical University, Tokyo, Japan.
Yukio SatoDepartment of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan.
Junichi SasakiDepartment of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan.
Satoshi IwataDepartment of Microbiology, Tokyo Medical University, Tokyo, Japan.
Kimiko Ubukata *Department of Microbiology, Tokyo Medical University, Tokyo, Japan.

Funding

Japanese Ministry of Health, Labour and Welfare H22-013
6 · The paper itself

Abstract

purposeThe incidence of invasive Group A Streptococcus (iGAS) infection and streptococcal toxic shock syndrome (STSS) is increasing. Early detection and diagnosis of cases that may progress to STSS are currently difficult. In this study, we aimed to identify biomarkers and emm type, one of the virulence factors, associated with STSS development.

methodsIn this multicentre observational study including patients with iGAS infection (n = 305), we investigated the relative associations of host factors, clinical manifestations, biomarkers, and emm type with STSS.

resultsThe overall mortality rate was 15.4%; the fatality rate within 28 days of admission was higher in patients with STSS (67.9%, 38/56) than in those without (3.6%, 9/249). The most predominant type was emm1 (38%), detected in 73.2% of the patients with STSS. Risk factors for STSS identified by multivariable analysis included underlying kidney disease (odds ratio [OR], 10.7; 95% confidence interval [CI], 2.1-54.0, p = 0.004), bacteraemia without primary focus (OR, 3.6; 95% CI 1.2-11.1, p = 0.023), necrotizing fasciitis (OR, 8.7; 95% CI 2.6-29.4, p < 0.001), white blood cell count (WBC) < 4,000/µL (OR, 7.8; 95% CI 2.4-25.6, p = 0.001), serum creatine kinase (CK) ≥ 300 U/L (OR, 7.5; 95% CI 2.8-19.8, p < 0.001), and emm1 (OR, 5.2; 95% CI 2.0-13.4, p = 0.001).

conclusionWBC < 4,000/µL and CK level ≥ 300 U/L on admission are additional relevant biomarkers for STSS prediction. The most predominant iGAS type, emm1, was significantly associated with STSS.

Indexed as

Antigens, BacterialBacterial Outer Membrane ProteinsBiomarkersCarrier ProteinsShock, SepticStreptococcal InfectionsStreptococcus pyogenesAdultAgedAged, 80 and overEast Asian PeopleFemaleHumansJapanMaleMiddle AgedAntigens, BacterialBacterial Outer Membrane ProteinsBiomarkersCarrier Proteinsstreptococcal M proteinVirulence FactorsBiomarkerEmm typeInvasive group A Streptococcus infectionStreptococcal toxic shock syndrome

Identifiers

PMID40193020
PMCPMC12116948

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.