C-type natriuretic peptide is associated with the severity of Crimean-Congo hemorrhagic fever.
BACKGROUND
Crimean-Congo hemorrhagic fever (CCHF) is characterized by vascular dysfunction, indicating the involvement of endothelial cells. C-type natriuretic peptide (CNP) plays a critical role in the coordination of vascular tone and is associated with the prognosis in critically ill patients such as those with sepsis and septic shock. We investigated whether CNP is related to the severity of CCHF.


METHODS
Forty-eight consecutive patients with a laboratory confirmed diagnosis of CCHF and 40 age-sex-matched healthy volunteers as the control group were prospectively enrolled into the study. CCHF patients were classified according to the disease severity into a non-severe group (n=28) and a severe group (n=20).


RESULTS
The CNP levels were detected to be 0.43 (0.4-0.7) ng/ml in the control group, 0.87 (0.7-1.0) ng/ml in the non-severe CCFH group, and 1.27 (0.8-1.7) ng/ml in the severe CCHF group. According to the receiver operating characteristics curve analysis, the optimal cut-off value of CNP to predict disease severity was >1.22 ng/ml, with 89.3% specificity and 55% sensitivity. CNP >1.22 ng/ml, lactate dehydrogenase >480 IU/l, and aspartate aminotransferase >202 IU/l were found to have prognostic significance in the univariate analysis. In the multivariate logistic regression analysis by forward stepwise method, CNP >1.22 ng/ml (odds ratio 8.336, p = 0.016) and lactate dehydrogenase >480 IU/l (odds ratio 16.206, p = 0.002) remained associated with disease severity after adjustment for confounding variables.


CONCLUSIONS
CNP measurement could help in the risk stratification of patients with CCHF.
Department of Emergency, Isparta State Hospital, Isparta, Turkey.
Kenan Ahmet
KA
Turkdogan
Ali
A
Zorlu
Aynur
A
Engin
Fatma Mutlu Kukul
FM
Guven
Muhammed Mirhan
MM
Polat
Okan Onur
OO
Turgut
Mehmet Birhan
MB
Yilmaz
D000328:Adult; D000368:Aged; D005260:Female; D006479:Hemorrhagic Fever, Crimean / Q000097:blood* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020098:Natriuretic Peptide, C-Type / Q000097:blood*; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index
D020098:Natriuretic Peptide, C-Type