BACKGROUND: Platelet recovery was an important prognostic indicator in severe fever with thrombocytopenia syndrome (SFTS). This study focused on risk factors affecting platelet recovery in surviving SFTS patients, which can assist clinicians in the early screening of patients associated with a greater risk of mortality.

METHOD: We retrospectively analyzed the clinical data of SFTS patients admitted to Yantai Qishan Hospital throughout 2023. According to the Diagnosis and Treatment Guideline (2023 edition), the platelet recovery in 14 days was set as outcome. The multivariate Cox regression was used to identify independent risk factors affecting platelet recovery and the Kaplan-Meier was performed to evaluate the probability of 14-day platelet recovery, using receiver operating characteristic (ROC) curve and area under the curve (AUC) to measure the model's performance, with clinical benefit assessed by decision curve analysis (DCA).

RESULTS: 168 SFTS patients were enrolled in the study, with 76.2% (128/168) achieving platelet (PLT) recovery within 14 days. Independent risk factors were baseline PLT > 90 × 109/L (HR: 7.929, 95%CI: 1.066-58.990, P = 0.043), days from onset to admission >6 days (HR: 0.444, 95%CI: 0.259-0.763, P = 0.003) and baseline prothrombin time (PT) >13 s (HR: 0.547, 95%CI: 0.373-0.800, P = 0.002), with an AUC of 0.745 (95% CI: 0.656-0.834, P < 0.001). DCA demonstrated that when the recovery probability beyond approximately 50%, the clinical net benefit from focusing on the PLT stratification model consistently surpassed that from the all-intervention model. The nomogram further visualized the model.

CONCLUSION: Early diagnosis and timely therapy contributed to recovery during convalescence in SFTS patients, with baseline PT as a strong predictor.