Systemic Immune Inflammation Index as a Predictor of Disease Severity in Tetanus Patients

Systemic Immune Inflammation Index as a Predictor of Disease Severity in Tetanus Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Systemic Immune Inflammation Index as a Predictor of Disease Severity in Tetanus Patients Dai Cheng, Huang Jizheng, Sun Wei, Li Liang, Han Guolei, Yang Hao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3966154/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Objective This study aimed to analyze the predictive value of the systemic immune inflammation index (SII) for the severity of disease in tetanus patients. Methods Clinical data of 34 tetanus patients admitted to the Second People's Hospital of Fuyang from January 2019 to December 2022 were analyzed. Based on whether patients received intensive care unit (ICU) treatment after admission, the patients were divided into ICU and non-ICU groups. The diagnostic value of SII for the severity of tetanus was assessed. Results Among the 34 patients, 18 (52.90%) were classified into the ICU group, and 16 (47.10%) into the non-ICU group. There were statistically significant differences in white blood cell count, platelet count, neutrophil count, and SII between the two groups (P < 0.05). Logistic regression analysis revealed that SII was a risk factor for tetanus patients requiring ICU treatment. The area under the curve (AUC) for SII predicting ICU treatment in tetanus patients was 0.896 (95% CI 0.790–1.000, P < 0.001). Conclusion The SII can serve as an objective predictive indicator for tetanus patients requiring ICU treatment. Health sciences/Diseases/Infectious diseases Health sciences/Medical research/Biomarkers Tetanus Severity Risk factors Figures Figure 1 Introduction Tetanus is an infectious disease caused by Clostridium tetani, characterized by persistent, tonic contractions of skeletal muscles and paroxysmal spasms in patients[1-2]. Due to the nonspecific early clinical symptoms of tetanus, patients are typically initially admitted to general wards, and transfer to the intensive care unit (ICU) for treatment occurs when the condition becomes severe, leading to delayed intervention and posing a threat to patients' lives. Therefore, guidelines emphasize the need for more graded schemes and clinically relevant studies on prognosis[2-3]. The Systemic Immune Inflammation Index (SII) is a novel immunoinflammatory marker that integrates peripheral blood platelet, neutrophil, and lymphocyte counts. It is considered an effective indicator reflecting the systemic immune-inflammatory status and prognosis, with the formula: Neutrophil count (×10 9 /L) × Platelet count (×10 9 /L) / Lymphocyte count (×10 9 /L)[4]. Studies have shown that SII has excellent clinical value in assessing the prognosis of patients with rheumatoid arthritis, cancer, infectious diseases, and other conditions[5-8]. This study retrospectively analyzed the clinical treatment of 34 tetanus patients, exploring the clinical value of SII in predicting the severity of disease in tetanus patients. The findings are reported as follows. Materials and Methods 1.1 Study Subjects A retrospective review was conducted on tetanus patients admitted to the Second People's Hospital of Fuyang from January 2019 to December 2022. Inclusion criteria were as follows: ① Patients clinically diagnosed with tetanus; ② Complete clinical data. Exclusion criteria were: ① Discharge or death within 24 hours of admission; ② Incomplete clinical data. A total of 34 patients were included, comprising 22 males (64.70%) and 12 females (35.30%), with an average age of (62.06±12.88) years. 1.2 Data Collection Based on whether patients received intensive care unit (ICU) treatment after admission, the 34 patients were divided into ICU and non-ICU groups. Data recorded included patient gender, age, underlying diseases, Ablett classification, time from onset to medical treatment, total hospital stay, white blood cell count, platelet count, total bilirubin, creatinine, creatine kinase, creatine kinase isoenzyme, neutrophil count, lymphocyte count, and the Systemic Immune Inflammation Index (SII) calculated based on blood routine results. 1.3 Statistical Analysis Statistical analysis was performed using SPSS 22.0. Continuous data were expressed as "±s" and analyzed using independent sample t-tests. Categorical data were presented as case numbers (n) and percentages (%) and analyzed using χ² tests. Binary logistic regression analysis was used for multifactor analysis. Receiver Operating Characteristic (ROC) curves were drawn to analyze the diagnostic value of SII for the severity of tetanus, with the cutoff value determined as the point with the maximum Youden index. A significance level of P<0.05 indicated statistical significance. Results 2.1 Univariate Analysis of Tetanus Patients Receiving ICU Treatment Among the 34 patients, 18 (52.90%) were categorized into the ICU group, and 16 (47.10%) into the non-ICU group based on whether they received ICU treatment. There were no statistically significant differences between the two groups in terms of age, gender, underlying diseases, time from onset to medical treatment, total bilirubin, creatinine, creatine kinase, creatine kinase isoenzyme, and lymphocyte count (P>0.05). However, statistically significant differences were observed in white blood cell count, platelet count, neutrophil count, and the Systemic Immune Inflammation Index (SII) between the two groups (P<0.05). Refer to Table 1 for details. Table 1: Univariate Analysis of Tetanus Patients Receiving ICU Treatment Variable ICU Group（n=18） Non-ICU Group（n=16） c 2 / t Value P Value Gender［n(%)］ 0.216 0.642 Male 11（61.11） 11（68.75） Female 7（38.89） 5（31.25） Underlying Diseases［n(%)］ 2.862 0.091 Present 4（22.22） 8（50.00） Absent 14（77.78） 8（50.00） Age (years) 62.22±12.55 61.88±13.65 0.077 0.939 Time from Onset to Treatment (days) 2.78±1.66 3.88±3.59 -1.164 0.253 White Blood Cell Count（×10 9 ∕L) 10.00±3.14 6.55±1.99 3.776 0.001 Platelet Count（×10 9 ∕L) 284.28±81.61 219.13±68.19 2.508 0.017 Total Bilirubin（×10 9 ∕L) 15.33±5.36 16.37±9.54 -0.398 0.693 Creatinine（×10 9 ∕L) 62.39±11.88 63.94±11.11 -0.393 0.698 Creatine Kinase（×10 9 ∕L) 334.33±205.73 222.75±207.19 1.573 0.125 Creatine Kinase Isoenzyme（×10 9 ∕L) 21.11±10.77 18.50±16.33 0.556 0.582 Neutrophil Count（×10 9 ∕L) 8.16±3.36 4.27±1.84 4.114 <0.001 Lymphocyte Count（×10 9 ∕L) 1.45±0.78 1.61±0.58 -0.649 0.521 SII 2222.15±2197.33 624.84±349.71 3.041 0.007 2.2 Multivariate Analysis of Tetanus Patients Receiving ICU Treatment Building upon the results of univariate analysis, variables with statistically significant differences, including white blood cell count, platelet count, neutrophil count, and the Systemic Immune Inflammation Index (SII), were selected as independent variables. Binary logistic regression analysis was conducted with the acceptance of ICU treatment as the dependent variable. The results indicated that SII is a risk factor for tetanus patients requiring ICU treatment. Refer to Table 2 for details. Table 2: Multivariate Analysis of Tetanus Patients Receiving ICU Treatment Variable β Wald P Value OR 95% C.I.for OR Lower Upper SII 0.003 4.029 0.045 1.003 1.000 1.006 Neutrophil Count 0.673 3.399 0.065 1.961 0.958 4.010 Constant -6.844 6.282 0.012 0.001 2.3 Predictive Value of SII for Tetanus Patients Receiving ICU Treatment The SII demonstrated significant predictive value for tetanus patients requiring ICU treatment, with an area under the curve (AUC) of 0.896 (95% CI 0.790–1.000, P<0.001). At the optimal cutoff value of 892.98, the sensitivity of SII in predicting tetanus patients requiring ICU treatment was 83.3%, with a specificity of 87.5%. Refer to Figure 1 for the ROC curve illustrating the predictive performance of SII. Figure 1: ROC Curve of SII for Predicting ICU Treatment in Tetanus Patients 2.4 Prognosis The prognosis of tetanus patients varied based on the initial treatment location. Among those initially treated in the ICU, 6 patients were admitted, 5 were cured, and 1 patient opted for treatment discontinuation. For patients transferred from general wards to the ICU, 12 were admitted, 9 were cured, and 3 patients chose to discontinue treatment. One patient initially admitted to a general ward, who deteriorated but refused transfer to the ICU, opted for treatment discontinuation. All 15 patients continuously treated in general wards were cured. Refer to Table 3 for a comparison of the cure rates among different treatment groups. Table 3: Comparison of Cure Rates in Different Initial Treatment Settings Group Total Number (cases) Discontinuation/Death (cases) Cured (cases) Cure Rate (%) First ICU Treatment 6 1/0 5 83.33 Transfer to ICU Treatment 12 3/0 9 75.00 Continuous General Ward Treatment 15 0/0 15 100.00 Total 33 4/0 29 87.88 Discussion Tetanus is a vaccine-preventable disease that remains prevalent in many low- and middle-income countries, posing ongoing challenges[9-10]. Studies suggest that early initiation of intensive care and nursing for severe and very severe (Ⅲ/Ⅳ grade) patients can reduce the mortality rate among tetanus patients[11-12]. Therefore, predicting the severity of tetanus is crucial for patient treatment and prognosis. Currently, the assessment of tetanus severity often relies on the Ablett grading system[2,13]. In this study, 13 patients initially admitted to general wards based on Ablett grading later required transfer to the ICU as their conditions worsened. Some patients exhibited mild symptoms upon admission and deteriorated after being admitted to general wards, leading to delayed ICU treatment. Cai Miaotian et al.[14] highlighted the limitations of the Ablett grading system, emphasizing its subjective nature and lack of quantitative precision. In contrast, the Systemic Immune Inflammation Index (SII) can predict the severity of the disease upon admission, guiding ICU admission and allowing for early intervention to prevent progression to severe conditions. In this study, the AUC of the ROC curve for SII predicting ICU treatment in tetanus patients was 0.896, demonstrating high sensitivity and specificity. In summary, the SII is a convenient and cost-effective indicator that can serve as an objective predictor for tetanus patients requiring ICU treatment. However, due to the small sample size in this study, further confirmation through larger-scale research is warranted. Additionally, the lack of dynamic monitoring of SII changes during hospitalization and the absence of an in-depth exploration of the correlation between SII changes and the severity of the patient's condition require further investigation in future studies. Declarations Ethics Statement The studies involving human participants were reviewed and approved by Ethics Committee of No.2 People's Hospital of Fuyang City(20231210056).The patients/participants provided their written informed consent to participate in this study. All methods were implemented in accordance with relevant guidelines and regulations. Author Contribution Dai Cheng and Huang Jizheng wrote the main manuscript text.Sun Wei,Li Liang,Han Guolei and Yang Hao prepared Table 1-3 and figures 1. All authors reviewed the manuscript. Data Availability Statement The data that support the findings of this study are available from the corresponding author, upon reasonable request. References Yen LM, Thwaites CL.Tetanus[J].Lancet.2019;393(10181):1657–1668. doi: 10.1016/S0140-6736(18)33131-3 Wang CL, Liu S, Chen QJ, et.al. [Specifications for diagnosis and treatment of non-neonatal tetanus[J]. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):162–166. Chinese. doi: 10.3760/cma.j.issn.0254-6450.2020.02.005 . WEI Jin-gang, WANG Su-xing, QIN Hao. Epidemiological characteristics and deathrisk analysis of severe tetanus in a tertiary hospital, 2008-2018 [J]. Pract Prev Med,2020,27(01):50–53. Hu B, Yang XR, Xu Y,et.al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma[J]. Clin Cancer Res,20(23):6212–22. doi: 10.1158/1078-0432.CCR-14-0442 . Liu, B, Wang, J, Li, Y. Y.et al. The association between systemic immune-inflammation index and rheumatoid arthritis: evidence from NHANES 1999–2018[J]. Arthritis research & therapy, 25 (1), 34.DOI: 10.1186/s13075-023-03018-6 LI Pei-hang, LU Jia-li, YUE Jin-bo.Relationship between platelet-to- lymphocyte ratioand systemic immune inflammation index and prognostic outcomes in patients with advanced renal cell carcinoma treated with immune checkpoint inhibitors [J]. Chin J Cancer Prev Treat,2022,29(07):523–530.DOI: 10.16073/j.cnki.cjcpt.2022.07.12 . Cui Z, Kuang S, Yang X, et al. Predictive value of the systemic immune inflammation (SII) index for stroke-associated pneumonia[J]. Brain Behav. 2023;13(12):e3302. doi: 10.1002/brb3.3302 . Muhammad S, Fischer I, Naderi S,et al. Systemic Inflammatory Index Is a Novel Predictor of Intubation Requirement and Mortality after SARS-CoV-2 Infection. Pathogens[J]. 2021,10(1):58. doi: 10.3390/pathogens10010058 . Chalya PL, Mabula JB, Dass RM, et al. Ten-year experiences with Tetanus at a Tertiary hospital in Northwestern Tanzania: A retrospective review of 102 cases[J].World Journal of Emergency Surgery, 2011, 6(1):20–27. Nóbrega MV, Reis RC, Oluk AI ,et al .Patients with severe accidental tetanus admitted to an intensive care unit in Northeastern Brazil: clinical-epidemiological profile andrisk factors for mortality [J].Braz J Infect Dis,2016;20(5):457–461 Fan Z, Zhao Y, Wang S, et al. Clinical features and outcomes of tetanus:a retrospective study[J].Infect Drug Resist, 2019,12:1289–1293. Mahieu R, Reydel T, Maamar A, et al. Admission of tetanus patients to the ICU:a retrospective multicentre study[J]. Ann. Intensive Care, 2017, 7(1):112–118. ZHANG Xiao meng, WANG Yan hua, WANG Chuan lin.. Diagnosis and treatment of severe adult tetanus [J]. Chi J of Emerg Resusc Disaster Med,2018,13(11):1087–1093. DOI: 10.3969/j.issn.1673-6966.2018.11.014 . Cai Miaotian, Liang Lianchun, Li Tongzeng,et.al. Analysis of clinical features and prognostic factors of tetanus [J].BEIJING MEDICAL JOURNAL,2018,40(04):318–322.DOI: 10.15932/j.0253-9713.2018.04.008 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 11 Mar, 2024 Reviewers agreed at journal 10 Mar, 2024 Reviewers invited by journal 08 Mar, 2024 Editor assigned by journal 08 Mar, 2024 Editor invited by journal 07 Mar, 2024 Submission checks completed at journal 07 Mar, 2024 First submitted to journal 18 Feb, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3966154","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":277922692,"identity":"e89dd6ec-333d-4289-aec5-188488ec78de","order_by":0,"name":"Dai Cheng","email":"","orcid":"","institution":"Department of Intensive Care Medicine, No.2 People's Hospital of Fuyang City","correspondingAuthor":false,"prefix":"","firstName":"Dai","middleName":"","lastName":"Cheng","suffix":""},{"id":277922693,"identity":"5c3b9e2a-d2e4-4f7f-a712-44773dcc33d8","order_by":1,"name":"Huang Jizheng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvElEQVRIiWNgGAWjYBACA4YDbAwMBQxybOzNB0jRYsBgzMdzLIFYLQxgLYnzJHIUiNNiznj82QMGg8PpbQw5DAw/KrYR1mLZcCDdAKglt43h7AHGnjO3iXDYgQPHJMBaGPsSmBnbiNJysA2kJZ2NmceAWC2H2UBaEtjYiNdyDKQl3bCNhy3hIHF+uXH8mQRDhbW8/PzHBx/8qCBCC4PEAQbmPwzNYPYBItQDAX8DiKwjTvEoGAWjYBSMTAAA9Z87LAB/BpEAAAAASUVORK5CYII=","orcid":"","institution":"Department of Hospital Infection Management, No.2 People's Hospital of Fuyang City","correspondingAuthor":true,"prefix":"","firstName":"Huang","middleName":"","lastName":"Jizheng","suffix":""},{"id":277922694,"identity":"23ad26bd-d395-414a-8d4b-d3372428acca","order_by":2,"name":"Sun Wei","email":"","orcid":"","institution":"Department of Intensive Care Medicine, No.2 People's Hospital of Fuyang City","correspondingAuthor":false,"prefix":"","firstName":"Sun","middleName":"","lastName":"Wei","suffix":""},{"id":277922695,"identity":"38c89d61-909f-46fa-b95d-f354b15302f5","order_by":3,"name":"Li Liang","email":"","orcid":"","institution":"Department of Intensive Care Medicine, No.2 People's Hospital of Fuyang City","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Liang","suffix":""},{"id":277922696,"identity":"f3452eea-71b9-4898-8903-8c81b07c85f2","order_by":4,"name":"Han Guolei","email":"","orcid":"","institution":"Department of Intensive Care Medicine, No.2 People's Hospital of Fuyang City","correspondingAuthor":false,"prefix":"","firstName":"Han","middleName":"","lastName":"Guolei","suffix":""},{"id":277922697,"identity":"887a59ba-f564-47ed-b841-ba93828862df","order_by":5,"name":"Yang Hao","email":"","orcid":"","institution":"Department of Intensive Care Medicine, No.2 People's Hospital of Fuyang City","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Hao","suffix":""}],"badges":[],"createdAt":"2024-02-18 07:02:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3966154/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3966154/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52450744,"identity":"85eac4db-1688-46fb-a8e7-e1143e37bf07","added_by":"auto","created_at":"2024-03-11 19:08:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":7424,"visible":true,"origin":"","legend":"\u003cp\u003eROC Curve of SII for Predicting ICU Treatment in Tetanus Patients\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3966154/v1/589e25de4f2f821e286405da.png"},{"id":52450746,"identity":"2b337f34-1d26-419d-b6fe-44503af57015","added_by":"auto","created_at":"2024-03-11 19:08:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":198659,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3966154/v1/58317a53-2164-4ee9-997a-5337cfca1011.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Systemic Immune Inflammation Index as a Predictor of Disease Severity in Tetanus Patients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTetanus is an infectious disease caused by Clostridium tetani, characterized by persistent, tonic contractions of skeletal muscles and paroxysmal spasms in patients[1-2]. Due to the nonspecific early clinical symptoms of tetanus, patients are typically initially admitted to general wards, and transfer to the intensive care unit (ICU) for treatment occurs when the condition becomes severe, leading to delayed intervention and posing a threat to patients\u0026apos; lives. Therefore, guidelines emphasize the need for more graded schemes and clinically relevant studies on prognosis[2-3].\u003c/p\u003e\n\u003cp\u003eThe Systemic Immune Inflammation Index (SII) is a novel immunoinflammatory marker that integrates peripheral blood platelet, neutrophil, and lymphocyte counts. It is considered an effective indicator reflecting the systemic immune-inflammatory status and prognosis, with the formula: Neutrophil count (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L) \u0026times; Platelet count (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L) / Lymphocyte count (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)[4]. Studies have shown that SII has excellent clinical value in assessing the prognosis of patients with rheumatoid arthritis, cancer, infectious diseases, and other conditions[5-8]. This study retrospectively analyzed the clinical treatment of 34 tetanus patients, exploring the clinical value of SII in predicting the severity of disease in tetanus patients. The findings are reported as follows.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e1.1 Study Subjects\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA retrospective review was conducted on tetanus patients admitted to the Second People\u0026apos;s Hospital of Fuyang from January 2019 to December 2022. Inclusion criteria were as follows: ① Patients clinically diagnosed with tetanus; ② Complete clinical data. Exclusion criteria were: ① Discharge or death within 24 hours of admission; ② Incomplete clinical data. A total of 34 patients were included, comprising 22 males (64.70%) and 12 females (35.30%), with an average age of (62.06\u0026plusmn;12.88) years.\u003c/p\u003e\n\u003cp\u003e1.2 Data Collection\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBased on whether patients received intensive care unit (ICU) treatment after admission, the 34 patients were divided into ICU and non-ICU groups. Data recorded included patient gender, age, underlying diseases, Ablett classification, time from onset to medical treatment, total hospital stay, white blood cell count, platelet count, total bilirubin, creatinine, creatine kinase, creatine kinase isoenzyme, neutrophil count, lymphocyte count, and the Systemic Immune Inflammation Index (SII) calculated based on blood routine results.\u003c/p\u003e\n\u003cp\u003e1.3 Statistical Analysis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStatistical analysis was performed using SPSS 22.0. Continuous data were expressed as \u0026quot;\u0026plusmn;s\u0026quot; and analyzed using independent sample t-tests. Categorical data were presented as case numbers (n) and percentages (%) and analyzed using \u0026chi;\u0026sup2; tests. Binary logistic regression analysis was used for multifactor analysis. Receiver Operating Characteristic (ROC) curves were drawn to analyze the diagnostic value of SII for the severity of tetanus, with the cutoff value determined as the point with the maximum Youden index. A significance level of P\u0026lt;0.05 indicated statistical significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e2.1 Univariate Analysis of Tetanus Patients Receiving ICU Treatment\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Among the 34 patients, 18 (52.90%) were categorized into the ICU group, and 16 (47.10%) into the non-ICU group based on whether they received ICU treatment. There were no statistically significant differences between the two groups in terms of age, gender, underlying diseases, time from onset to medical treatment, total bilirubin, creatinine, creatine kinase, creatine kinase isoenzyme, and lymphocyte count (P\u0026gt;0.05). However, statistically significant differences were observed in white blood cell count, platelet count, neutrophil count, and the Systemic Immune Inflammation Index (SII) between the two groups (P\u0026lt;0.05). Refer to Table 1 for details.\u003c/p\u003e\n\u003cp\u003eTable 1: Univariate Analysis of Tetanus Patients Receiving ICU Treatment\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"587\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.086882453151617%\" colspan=\"2\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.31686541737649%\"\u003e\n \u003cp\u003eICU\u0026nbsp;\u0026nbsp;Group（n=18）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5553662691652472%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.531516183986373%\"\u003e\n \u003cp\u003eNon-ICU Group（n=16）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.776831345826235%\"\u003e\n \u003cp\u003ec\u003csup\u003e2\u003c/sup\u003e/\u003cem\u003e\u0026nbsp;t Value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.732538330494037%\"\u003e\n \u003cp\u003e\u003cem\u003eP Value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.986394557823129%\"\u003e\n \u003cp\u003eGender［n(%)］\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.27891156462585%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5510204081632653%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\"\u003e\n \u003cp\u003e0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.714285714285714%\"\u003e\n \u003cp\u003e0.642\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.986394557823129%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.27891156462585%\"\u003e\n \u003cp\u003e11（61.11）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5510204081632653%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\"\u003e\n \u003cp\u003e11（68.75）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.714285714285714%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.986394557823129%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.27891156462585%\"\u003e\n \u003cp\u003e7（38.89）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5510204081632653%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\"\u003e\n \u003cp\u003e5（31.25）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.714285714285714%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.986394557823129%\"\u003e\n \u003cp\u003eUnderlying Diseases［n(%)］\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.27891156462585%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5510204081632653%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\"\u003e\n \u003cp\u003e2.862\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.714285714285714%\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.986394557823129%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.27891156462585%\"\u003e\n \u003cp\u003e4（22.22）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5510204081632653%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\"\u003e\n \u003cp\u003e8（50.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.714285714285714%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.986394557823129%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.27891156462585%\"\u003e\n \u003cp\u003e14（77.78）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5510204081632653%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\"\u003e\n \u003cp\u003e8（50.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.714285714285714%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.086882453151617%\" colspan=\"2\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.31686541737649%\"\u003e\n \u003cp\u003e62.22\u0026plusmn;12.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5553662691652472%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.531516183986373%\"\u003e\n \u003cp\u003e61.88\u0026plusmn;13.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.776831345826235%\"\u003e\n \u003cp\u003e0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.732538330494037%\"\u003e\n \u003cp\u003e0.939\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.086882453151617%\" colspan=\"2\"\u003e\n \u003cp\u003eTime from Onset to Treatment (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.31686541737649%\"\u003e\n \u003cp\u003e2.78\u0026plusmn;1.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5553662691652472%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.531516183986373%\"\u003e\n \u003cp\u003e3.88\u0026plusmn;3.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.776831345826235%\"\u003e\n \u003cp\u003e-1.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.732538330494037%\"\u003e\n \u003cp\u003e0.253\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.086882453151617%\" colspan=\"2\"\u003e\n \u003cp\u003eWhite Blood Cell Count（\u0026times;10\u003csup\u003e9\u003c/sup\u003e∕L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.31686541737649%\"\u003e\n \u003cp\u003e10.00\u0026plusmn;3.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5553662691652472%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.531516183986373%\"\u003e\n \u003cp\u003e6.55\u0026plusmn;1.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.776831345826235%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.776\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.732538330494037%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.086882453151617%\" colspan=\"2\"\u003e\n \u003cp\u003ePlatelet Count（\u0026times;10\u003csup\u003e9\u003c/sup\u003e∕L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.31686541737649%\"\u003e\n \u003cp\u003e284.28\u0026plusmn;81.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5553662691652472%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.531516183986373%\"\u003e\n \u003cp\u003e219.13\u0026plusmn;68.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.776831345826235%\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.508\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.732538330494037%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.017\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.086882453151617%\" colspan=\"2\"\u003e\n \u003cp\u003eTotal Bilirubin（\u0026times;10\u003csup\u003e9\u003c/sup\u003e∕L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.31686541737649%\"\u003e\n \u003cp\u003e15.33\u0026plusmn;5.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5553662691652472%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.531516183986373%\"\u003e\n \u003cp\u003e16.37\u0026plusmn;9.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.776831345826235%\"\u003e\n \u003cp\u003e-0.398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.732538330494037%\"\u003e\n \u003cp\u003e0.693\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.086882453151617%\" colspan=\"2\"\u003e\n \u003cp\u003eCreatinine（\u0026times;10\u003csup\u003e9\u003c/sup\u003e∕L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.31686541737649%\"\u003e\n \u003cp\u003e62.39\u0026plusmn;11.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5553662691652472%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.531516183986373%\"\u003e\n \u003cp\u003e63.94\u0026plusmn;11.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.776831345826235%\"\u003e\n \u003cp\u003e-0.393\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.732538330494037%\"\u003e\n \u003cp\u003e0.698\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.086882453151617%\" colspan=\"2\"\u003e\n \u003cp\u003eCreatine Kinase（\u0026times;10\u003csup\u003e9\u003c/sup\u003e∕L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.31686541737649%\"\u003e\n \u003cp\u003e334.33\u0026plusmn;205.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5553662691652472%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.531516183986373%\"\u003e\n \u003cp\u003e222.75\u0026plusmn;207.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.776831345826235%\"\u003e\n \u003cp\u003e1.573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.732538330494037%\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.086882453151617%\" colspan=\"2\"\u003e\n \u003cp\u003eCreatine Kinase Isoenzyme（\u0026times;10\u003csup\u003e9\u003c/sup\u003e∕L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.31686541737649%\"\u003e\n \u003cp\u003e21.11\u0026plusmn;10.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5553662691652472%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.531516183986373%\"\u003e\n \u003cp\u003e18.50\u0026plusmn;16.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.776831345826235%\"\u003e\n \u003cp\u003e0.556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.732538330494037%\"\u003e\n \u003cp\u003e0.582\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.086882453151617%\" colspan=\"2\"\u003e\n \u003cp\u003eNeutrophil Count（\u0026times;10\u003csup\u003e9\u003c/sup\u003e∕L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.31686541737649%\"\u003e\n \u003cp\u003e8.16\u0026plusmn;3.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5553662691652472%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.531516183986373%\"\u003e\n \u003cp\u003e4.27\u0026plusmn;1.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.776831345826235%\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.114\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.732538330494037%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.086882453151617%\" colspan=\"2\"\u003e\n \u003cp\u003eLymphocyte Count（\u0026times;10\u003csup\u003e9\u003c/sup\u003e∕L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.31686541737649%\"\u003e\n \u003cp\u003e1.45\u0026plusmn;0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5553662691652472%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.531516183986373%\"\u003e\n \u003cp\u003e1.61\u0026plusmn;0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.776831345826235%\"\u003e\n \u003cp\u003e-0.649\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.732538330494037%\"\u003e\n \u003cp\u003e0.521\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.086882453151617%\" colspan=\"2\"\u003e\n \u003cp\u003eSII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.31686541737649%\"\u003e\n \u003cp\u003e2222.15\u0026plusmn;2197.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5553662691652472%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.531516183986373%\"\u003e\n \u003cp\u003e624.84\u0026plusmn;349.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.776831345826235%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.041\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.732538330494037%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e2.2 Multivariate Analysis of Tetanus Patients Receiving ICU Treatment\u003c/p\u003e\n\u003cp\u003eBuilding upon the results of univariate analysis, variables with statistically significant differences, including white blood cell count, platelet count, neutrophil count, and the Systemic Immune Inflammation Index (SII), were selected as independent variables. Binary logistic regression analysis was conducted with the acceptance of ICU treatment as the dependent variable. The results indicated that SII is a risk factor for tetanus patients requiring ICU treatment. Refer to Table 2 for details.\u003c/p\u003e\n\u003cp\u003eTable 2: Multivariate Analysis of Tetanus Patients Receiving ICU Treatment\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"574\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.247386759581882%\" rowspan=\"2\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.763066202090592%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.763066202090592%\" rowspan=\"2\"\u003e\n \u003cp\u003eWald\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.763066202090592%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e \u0026nbsp;Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.763066202090592%\" rowspan=\"2\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.700348432055748%\" colspan=\"2\"\u003e\n \u003cp\u003e95% C.I.for OR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.277486910994764%\"\u003e\n \u003cp\u003eSII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.787085514834207%\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.787085514834207%\"\u003e\n \u003cp\u003e4.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.787085514834207%\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.787085514834207%\"\u003e\n \u003cp\u003e1.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.787085514834207%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.787085514834207%\"\u003e\n \u003cp\u003e1.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.277486910994764%\"\u003e\n \u003cp\u003eNeutrophil Count\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.787085514834207%\"\u003e\n \u003cp\u003e0.673\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.787085514834207%\"\u003e\n \u003cp\u003e3.399\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.787085514834207%\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.787085514834207%\"\u003e\n \u003cp\u003e1.961\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.787085514834207%\"\u003e\n \u003cp\u003e0.958\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.787085514834207%\"\u003e\n \u003cp\u003e4.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.277486910994764%\"\u003e\n \u003cp\u003eConstant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.787085514834207%\"\u003e\n \u003cp\u003e-6.844\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.787085514834207%\"\u003e\n \u003cp\u003e6.282\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.787085514834207%\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.787085514834207%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.787085514834207%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.787085514834207%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e2.3 Predictive Value of SII for Tetanus Patients Receiving ICU Treatment\u003c/p\u003e\n\u003cp\u003eThe SII demonstrated significant predictive value for tetanus patients requiring ICU treatment, with an area under the curve (AUC) of 0.896 (95% CI 0.790\u0026ndash;1.000, P\u0026lt;0.001). At the optimal cutoff value of 892.98, the sensitivity of SII in predicting tetanus patients requiring ICU treatment was 83.3%, with a specificity of 87.5%. Refer to Figure 1 for the ROC curve illustrating the predictive performance of SII.\u003c/p\u003e\n\u003cp\u003eFigure 1: ROC Curve of SII for Predicting ICU Treatment in Tetanus Patients\u003c/p\u003e\n\u003cp\u003e2.4 Prognosis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe prognosis of tetanus patients varied based on the initial treatment location. Among those initially treated in the ICU, 6 patients were admitted, 5 were cured, and 1 patient opted for treatment discontinuation. For patients transferred from general wards to the ICU, 12 were admitted, 9 were cured, and 3 patients chose to discontinue treatment. One patient initially admitted to a general ward, who deteriorated but refused transfer to the ICU, opted for treatment discontinuation. All 15 patients continuously treated in general wards were cured. Refer to Table 3 for a comparison of the cure rates among different treatment groups.\u003c/p\u003e\n\u003cp\u003eTable 3: Comparison of Cure Rates in Different Initial Treatment Settings\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"542\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.33579335793358%\" valign=\"top\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.498154981549815%\" valign=\"top\"\u003e\n \u003cp\u003eTotal Number (cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.00369003690037%\" valign=\"top\"\u003e\n \u003cp\u003eDiscontinuation/Death (cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\" valign=\"top\"\u003e\n \u003cp\u003eCured (cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.00369003690037%\" valign=\"top\"\u003e\n \u003cp\u003eCure Rate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.33579335793358%\" valign=\"top\"\u003e\n \u003cp\u003eFirst ICU Treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.498154981549815%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.00369003690037%\" valign=\"top\"\u003e\n \u003cp\u003e1/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.00369003690037%\" valign=\"top\"\u003e\n \u003cp\u003e83.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.33579335793358%\" valign=\"top\"\u003e\n \u003cp\u003eTransfer to ICU Treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.498154981549815%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.00369003690037%\" valign=\"top\"\u003e\n \u003cp\u003e3/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.00369003690037%\" valign=\"top\"\u003e\n \u003cp\u003e75.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.33579335793358%\"\u003e\n \u003cp\u003eContinuous General Ward Treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.498154981549815%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.00369003690037%\"\u003e\n \u003cp\u003e0/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.00369003690037%\" valign=\"top\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.33579335793358%\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.498154981549815%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.00369003690037%\"\u003e\n \u003cp\u003e4/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.00369003690037%\" valign=\"top\"\u003e\n \u003cp\u003e87.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eTetanus is a vaccine-preventable disease that remains prevalent in many low- and middle-income countries, posing ongoing challenges[9-10]. Studies suggest that early initiation of intensive care and nursing for severe and very severe (Ⅲ/Ⅳ grade) patients can reduce the mortality rate among tetanus patients[11-12]. Therefore, predicting the severity of tetanus is crucial for patient treatment and prognosis.\u003c/p\u003e\n\u003cp\u003eCurrently, the assessment of tetanus severity often relies on the Ablett grading system[2,13]. In this study, 13 patients initially admitted to general wards based on Ablett grading later required transfer to the ICU as their conditions worsened. Some patients exhibited mild symptoms upon admission and deteriorated after being admitted to general wards, leading to delayed ICU treatment. Cai Miaotian et al.[14] highlighted the limitations of the Ablett grading system, emphasizing its subjective nature and lack of quantitative precision. In contrast, the Systemic Immune Inflammation Index (SII) can predict the severity of the disease upon admission, guiding ICU admission and allowing for early intervention to prevent progression to severe conditions. In this study, the AUC of the ROC curve for SII predicting ICU treatment in tetanus patients was 0.896, demonstrating high sensitivity and specificity.\u003c/p\u003e\n\u003cp\u003eIn summary, the SII is a convenient and cost-effective indicator that can serve as an objective predictor for tetanus patients requiring ICU treatment. However, due to the small sample size in this study, further confirmation through larger-scale research is warranted. Additionally, the lack of dynamic monitoring of SII changes during hospitalization and the absence of an in-depth exploration of the correlation between SII changes and the severity of the patient\u0026apos;s condition require further investigation in future studies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics Statement\u003c/h2\u003e \u003cp\u003e The studies involving human participants were reviewed and approved by Ethics Committee of No.2 People's Hospital of Fuyang City(20231210056).The patients/participants provided their written informed consent to participate in this study. All methods were implemented in accordance with relevant guidelines and regulations.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eDai Cheng and Huang Jizheng wrote the main manuscript text.Sun Wei,Li Liang,Han Guolei and Yang Hao prepared Table 1-3 and figures 1. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability Statement\u003c/h2\u003e \u003cp\u003eThe data that support the findings of this study are available from the corresponding author, upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eYen LM, Thwaites CL.Tetanus[J].Lancet.2019;393(10181):1657\u0026ndash;1668. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(18)33131-3\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(18)33131-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang CL, Liu S, Chen QJ, et.al. [Specifications for diagnosis and treatment of non-neonatal tetanus[J]. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):162\u0026ndash;166. 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Pathogens[J]. 2021,10(1):58. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/pathogens10010058\u003c/span\u003e\u003cspan address=\"10.3390/pathogens10010058\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChalya PL, Mabula JB, Dass RM, et al. Ten-year experiences with Tetanus at a Tertiary hospital in Northwestern Tanzania: A retrospective review of 102 cases[J].World Journal of Emergency Surgery, 2011, 6(1):20\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eN\u0026oacute;brega MV, Reis RC, Oluk AI ,et al .Patients with severe accidental tetanus admitted to an intensive care unit in Northeastern Brazil: clinical-epidemiological profile andrisk factors for mortality [J].Braz J Infect Dis,2016;20(5):457\u0026ndash;461\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFan Z, Zhao Y, Wang S, et al. Clinical features and outcomes of tetanus:a retrospective study[J].Infect Drug Resist, 2019,12:1289\u0026ndash;1293.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMahieu R, Reydel T, Maamar A, et al. Admission of tetanus patients to the ICU:a retrospective multicentre study[J]. Ann. Intensive Care, 2017, 7(1):112\u0026ndash;118.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZHANG Xiao meng, WANG Yan hua, WANG Chuan lin.. Diagnosis and treatment of severe adult tetanus [J]. Chi J of Emerg Resusc Disaster Med,2018,13(11):1087\u0026ndash;1093. DOI:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3969/j.issn.1673-6966.2018.11.014\u003c/span\u003e\u003cspan address=\"10.3969/j.issn.1673-6966.2018.11.014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCai Miaotian, Liang Lianchun, Li Tongzeng,et.al. Analysis of clinical features and prognostic factors of tetanus [J].BEIJING MEDICAL JOURNAL,2018,40(04):318\u0026ndash;322.DOI:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.15932/j.0253-9713.2018.04.008\u003c/span\u003e\u003cspan address=\"10.15932/j.0253-9713.2018.04.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Tetanus, Severity, Risk factors","lastPublishedDoi":"10.21203/rs.3.rs-3966154/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3966154/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aimed to analyze the predictive value of the systemic immune inflammation index (SII) for the severity of disease in tetanus patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eClinical data of 34 tetanus patients admitted to the Second People's Hospital of Fuyang from January 2019 to December 2022 were analyzed. Based on whether patients received intensive care unit (ICU) treatment after admission, the patients were divided into ICU and non-ICU groups. The diagnostic value of SII for the severity of tetanus was assessed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong the 34 patients, 18 (52.90%) were classified into the ICU group, and 16 (47.10%) into the non-ICU group. There were statistically significant differences in white blood cell count, platelet count, neutrophil count, and SII between the two groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Logistic regression analysis revealed that SII was a risk factor for tetanus patients requiring ICU treatment. The area under the curve (AUC) for SII predicting ICU treatment in tetanus patients was 0.896 (95% CI 0.790\u0026ndash;1.000, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe SII can serve as an objective predictive indicator for tetanus patients requiring ICU treatment.\u003c/p\u003e","manuscriptTitle":"Systemic Immune Inflammation Index as a Predictor of Disease Severity in Tetanus Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-11 19:08:36","doi":"10.21203/rs.3.rs-3966154/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2024-03-11T17:41:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2e5f845e-57aa-403f-b47b-2d2bae7bb412","date":"2024-03-10T14:56:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-03-08T05:07:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-08T05:03:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-03-07T07:22:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-07T07:14:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-02-18T07:01:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6e45e105-1272-480b-a047-302d1ef9514b","owner":[],"postedDate":"March 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":29277397,"name":"Health sciences/Diseases/Infectious diseases"},{"id":29277398,"name":"Health sciences/Medical research/Biomarkers"}],"tags":[],"updatedAt":"2024-03-11T19:08:36+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-11 19:08:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3966154","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3966154","identity":"rs-3966154","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}