Abstract: Objective To investigate the inflammation markers and associated risk factors for moderate-to-severe hepatic dysfunction in patients with tsutsugamushi disease presenting with liver impairment. Methods A retrospective study was conducted on 143 hospitalized patients diagnosed with scrub typhus at Nanjing Drum Tower Hospital Group Suqian Hospital from January 2016 to December 2020. Based on alanine aminotransferase levels, patients were categorized into normal liver function, mild liver function impairment, and moderate-to-severe liver function impairment groups. Statistically significant items underwent Multivariate logistic regression analysis to determine independent risk factors for liver impairment. Results In patients with Tsutsugamushi disease, there were no statistically significant differences in gender, age, and duration of diabetes among those with normal liver function, mild liver fuction impairment, and moderate to severe liver function impairment (P>0.05). The biochemical markers, specifically total bilirubin levels (11.12±5.66, 12.77±12.55, 10.78±3.93 μmol/L, χ²=0.226), showed no statistical difference (P>0.05). Patients with moderate to severe liver function impairment had a significantly longer hospital stay (12.67±5.25 d), and elevated levels of lymphocyte count (3.19±1.51×10⁹/L), alanine aminotransferase (190.45±97.66 U/L), aspartate aminotransferase (142.24±95.94 U/L), glutamyl transpeptidase (152.38±133.05 U/L), alkaline phosphatase (144.96±82.29 U/L), β2- microglobulin (7.17±9.13 mg/L ), fibrinogen (3.60±0.54 g/L ) and C-reactive protein (44.61±17.10 mg/L ). These values were significantly higher compard to the normal liver function group and mild liver duction impairment group. The differences were statistically significant (β2 values provided, P<0.05). Multivariate logstic regression analysis indicated that white blood cell count(OR=0.536, 95% CI: 0.348～0.826), lymphocyte count (OR=3.457, 95% CI: 1.736~6.884 ), platelet count (OR=0.979, 95% CI: 0.960~0.998), fibrinogen (OR=5.275, 95% CI: 1.686~16.507), and β2-microglobulin (OR=2.011, 95% CI: 1.169~3.460) were independent risk factors for the occurrence of moderate to severe liver fuction impairment in Tsutsugamushi disease patients(P<0.05). The area under the ROC curve was highest for lymphocyte count (0.678), followed by fibrinogen (0.674), and β2-macroglobulin (0.672), It was lowest for white blood cell count (0.337), and platelet count (0.281). Conclusion The combined assessment of white blood cell count, lymphocyte count, platelet count, fibrinogen, and β2-microglobulin levels in patients with Tsutsugamushi disease provides insights into the extent of liver function damage. This combined approach holds significant clinical value for evaluating the progression of the disease.

Key words: Scrub typhus, Liver function damage, Risk factor