LPC(16:0) and prothrombin time as mortality predictors in severe fever with thrombocytopenia syndrome

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne viral disease with a high fatality rate. However, the impact of the SFTS virus (SFTSV) on host lipid metabolism and its relationship with the prognosis of patients remain unclear. To determine the lipid metabolism profile of SFTSV-infected and identify prognostic biomarkers, targeted lipidomics analysis was conducted on SFTSV-infected Huh7 cells and serum samples from 71 subjects (including 15 healthy controls, 35 SFTS survivors, and 21 SFTS deceased patients) in this study. Our findings revealed that glycerophospholipid metabolism was the most significantly disrupted pathway in both SFTSV-infected Huh7 cells and SFTS patients, with lysophosphatidylcholine (LPC) species, including LPC(16:1), LPC(18:1), LPC(16:0), and LPC(18:0), showing decreased levels. Together with clinical parameters, prothrombin time (PT) and LPC(16:0) were further identified as prognostic factors, and the combined model incorporating these two markers predicted mortality with an area under the curve (AUC) of 0.937. These findings provide a foundation for mortality prediction and mechanistic understanding of SFTS.IMPORTANCEEffective prognostic tools and targeted therapies for SFTS remain urgently needed, as current clinical management relies largely on supportive care and lacks reliable indicators for early risk stratification. This study enhances our understanding of lipid alterations following SFTSV infection, opens potential avenues for metabolism-targeted intervention, and may aid in assessing disease progression and guiding appropriate clinical interventions.