Objective Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with high mortality rates. While previous studies have focused primarily on the epidemiological and clinical aspects of SFTS, indicators of renal injury at admission have received limited attention.
Methods We retrospectively analyzed 260 patients with SFTS admitted to the study hospital between April 1, 2023, and July 18, 2024, who were classified into the survival group (n = 163) and death group (n = 97) on the basis of 28-day prognosis. Renal-related data were collected upon admission. Univariate and multivariate Cox regression analyses were used to identify independent predictors, and a nomogram was constructed. Receiver operating characteristic (ROC) curves and calibration curves were used to assess the discrimination and calibration of the model. Kaplan–Meier curves were used to assess the cumulative survival rate of patients with these risk factors. External validation was conducted in 40 patients with SFTS who were admitted to an affiliated branch hospital during the same period.
Results The 28-day mortality rate was 37.3% (97/260). Multivariate analysis revealed age (HR = 1.053; 95% CI 1.027–1.079; P < 0.001), viral load (HR = 2.006; 95% CI 1.684–2.390; P < 0.001), and UREA (HR = 1.059; 95% CI 1.027–1.093; P < 0.001) as independent risk factors. The area under the curve (AUC) of the nomogram was 0.900 (95% CI 0.861–0.937), with 82.5% sensitivity and 84.0% specificity at the optimal cutoff (0.292). The calibration curve showed close agreement between the predicted and observed probability lines, indicating good model calibration. External validation yielded an AUC of 0.863 (95% CI 0.723–0.954), confirming favorable performance.
Conclusion Renal injury-related indicators at admission were strongly associated with fatal outcomes in patients with SFTS. Nomograms based on age, viral load, and UREA provide accurate and easily applicable tools for early risk stratification and may support individualized clinical management.
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