Application of entropy weight method to construct a diagnostic model of atypical scrub typhus suitable for primary healthcare organizations
Objective To improve the early diagnosis and treatment ability of atypical scrub typhus without scotoma in primary healthcare organizations in Yulin City,to effectively control the epidemic of scrub typhus,and to construct a diagnostic model for atypical scrub typhus applicable to the subtropical regions of Southern China and Southwest China.Methods Patients with fever who were first diagnosed in the respiratory department of Yulin Red Cross Hospital from June 2016 to December 2022 were selected as the study objects.A total of 546 patients were included,including 335 males and 211 females,aged 14-100 years.Based on the characteristics of scrub typhus in three aspects:epidemiology,clinical manifestations,and physicochemical examination,the entropy weight method was applied to analyze the fever cases diagnosed as scrub typhus,atypical scrub typhus,and non-scrub typhus.The diagnostic model for atypical scrub typhus was determined after evaluation of the receiver operating characteristic curve(ROC),validation and optimization of the small samples.The diagnostic efficacy of the atypical scrub typhus diagnostic model and the Weil-Felix reaction OXK was evaluated in 77 suspected cases of scrub typhus using indirect immunofluorescent antibody test(IFAT)as the gold standard for diagnosing scrub typhus.x2 test was used.Results Based on the percentage of each diagnostic element of scrub typhus,the prototype diagnostic model for scrub typhus/atypical scrub typhus was determined,and the optimal cut-off value for ROC curve analysis was 2.95 points,with the corresponding area under the curve(AUC)of 0.962 8,and the sensitivity and specificity were 90.0％and 100.0％,respectively.The sensitivity and specificity of the secondary evaluation of the prototype diagnostic model in a small sample(25 cases)were 90.0％and 86.7％,respectively.There was no statistically significant difference in diagnostic efficacy between the diagnostic model of atypical scrub typhus and the IFAT in scrub typhus(P＞0.05),and the former's diagnosis of suspected scrub typhus cases had the following sensitivity,specificity,Youden index,compliance rate,and Kappa value of 96.7％,70.6％,0.67,90.9％,and 0.72,while there was a statistically significant difference in diagnostic efficacy between the Weil-Felix reaction OXK and the IFAT(P＜0.05),with corresponding diagnostic sensitivity,specificity,Youden index,compliance rate,and Kappa value of 5.0％,100.0％,0.05,26.0％,and 0.02,respectively.Conclusion The diagnostic model of atypical scrub typhus helps clinicians to objectively analyze non-specific clinical information,and provides an important reference for early diagnosis and treatment of scrub typhus,which is expected to be widely applied in primary medical institutions with limited diagnostic technology and equipment in Southern China and Southwest subtropical regions.
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