ArticleVirology journal2026
Association between serum calcium and in-hospital mortality in patients with severe fever with thrombocytopenia syndrome: a retrospective cohort study.
Article in Virology journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveSevere fever with thrombocytopenia syndrome (SFTS) is a viral infectious disease characterized by high mortality. Calcium dysregulation is implicated in viral replication and host immune response. We aimed to evaluate the association between serum calcium levels and in-hospital mortality in patients with SFTS.
methodsIn this retrospective, single-centre cohort study, we enrolled 809 laboratory-confirmed SFTS patients admitted between April 2017 and June 2024. Hypocalcemia was defined as corrected calcium < 8.12 mg/dL. Multivariate logistic regression, restricted cubic spline (RCS), and longitudinal analyses were employed to assess associations between serum calcium and mortality.
resultsThe in-hospital mortality rate was 11.87% (96/809). Hypocalcemia was observed in 72.68% of patients (588/809) with SFTS upon admission. Multivariate logistic regression analysis revealed that lower serum calcium was an independent predictor of in-hospital mortality, alongside older age, neurological symptoms, higher viral loads, lower albumin levels, elevated creatinine, and prolonged activated partial thromboplastin time (APTT). Restricted cubic spline (RCS) analysis suggested a visual L-shaped pattern between serum calcium levels and in-hospital mortality, but without statistically significant evidence of non-linearity. Dynamic analysis showed that serum calcium levels increased and normalized by day 6 in survivors but peaked and declined thereafter in non-survivors. Hypocalcemia was independently associated with hypoalbuminemia, hypoglobulinemia, hyponatremia, and monocytopenia. Furthermore, serum calcium levels were inversely correlated with viral load, creatine kinase, APTT, IL-6, and IL-10 (all p < 0.05).
conclusionsHypocalcemia is exceedingly common in SFTS patients and serves as a robust, independent prognostic marker for in-hospital mortality. Its association with high viral replication and host inflammatory response underscores its clinical significance. Serial monitoring of serum calcium may serve as a useful marker for risk stratification in SFTS.
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