title: Analysis of risk-factors among patients with Crimean-Congo haemorrhagic fever virus infection: severity criteria revisited.
abstract: The aim of this study was to determine the predictors of mortality among patients infected with Crimean-Congo haemorrhagic fever (CCHF) virus. Among patients with acute febrile syndrome, characterised by malaise, bleeding, leukopenia and thrombocytopenia, who were admitted to hospital during the spring and summer of 2002-2004, 54 had positive IgM and/or PCR results for CCHF virus in blood or tissue. The overall case fatality rate was 7.4%. Among the fatalities, haematemesis (p 0.009), melaena (p 0.001) and somnolence (p 0.022) were more common, the median platelet count was significantly lower (10,600/mL vs. 20,000/mL; p 0.038), the mean prothrombin time (27 s vs. 16 s; p 0.002) and mean activated partial thromboplastin time (73 s vs. 44 s; p < 0.001) were longer, and the mean alanine transferase (ALT) level (1,125 vs. 331; p < 0.001), the mean aspartate transferase (AST) level (3,118 vs. 913; p 0.004) and the mean fibrinogen level (119 vs. 340; p 0.012) were higher. Serum IgM and IgG against CCHF virus was detected in 25% and 0%, respectively, of fatal cases, compared with 94% and 62%, respectively, of cases with favourable outcomes. Oral ribavirin was prescribed to 22 (41%) patients. Of the four fatal cases, it was the intention to prescribe ribavirin to three patients, but this was not possible because of haematemesis and melaena. Higher levels of AST (>or= 700 U/L) and ALT (>or= 900 U/L) are suggested for use as severity criteria. Oral ribavirin was not effective for patients with haematemesis, and intravenous ribavirin is necessary for treatment of CCHF.
authors.affiliation: Infectious Diseases and Clinical Microbiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey. onderergonul@yahoo.com
authors.forename: O
authors.initials: O
authors.lastname: Ergonul
authors.forename: A
authors.initials: A
authors.lastname: Celikbas
authors.forename: N
authors.initials: N
authors.lastname: Baykam
authors.forename: S
authors.initials: S
authors.lastname: Eren
authors.forename: B
authors.initials: B
authors.lastname: Dokuzoguz
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000097:blood; D001774:Blood Chemical Analysis; D003710:Demography; D005260:Female; D003225:Hemorrhagic Fever Virus, Crimean-Congo / Q000235:genetics / Q000276:immunology; D006479:Hemorrhagic Fever, Crimean / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012254:Ribavirin / Q000627:therapeutic use; D012307:Risk Factors; D014421:Turkey / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase