title: Relationship of plasma cell-free DNA level with mortality and prognosis in patients with Crimean-Congo hemorrhagic fever.
abstract: Crimean-Congo hemorrhagic fever (CCHF) is a viral infection. Circulating plasma cell-free DNA (pcf-DNA) is a novel marker indicating cellular damage. So far, the role of pcf-DNA did not investigate in CCHF patients. In the current study, pcf-DNA levels were investigated in CCHF patients with different clinical severity grades to explore the relationship between circulating pcf-DNA level, virus load, and disease severity. Seventy-two patients were categorized as mild, intermediate, and severe based on severity grading scores. The pcf-DNA level was obtained from all participants on admission and from the survivors on the day of the discharge. The controls consisted of 31 healthy. Although the pcf-DNA level at admission was higher in patients than in the controls, the difference was not statistically significant (P = 0.291). However, at admission and in the convalescent period, the difference between pcf-DNA levels in mild, intermediate, and severe patient groups was significant. The pcf-DNA level in severe patients was higher than in the others. Furthermore, compared to survivors, non-survivors had higher pcf-DNA levels at admission (P = 0.001). A direct relationship was found between the pcf-DNA level and the viral load on the day of discharge in surviving patients. ROC curve analysis identified a pcf-DNA level of 0.42 as the optimal cut-off for prediction of mortality. The positive predictive value, negative predictive value, specificity, and sensitivity for predicting mortality was 100%, 72%, 100%, and 79%, respectively. In summary, our findings revealed that pcf-DNA levels may be used as a biomarker in predicting CHHF prognosis.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Bakir
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.
authors.forename: Aynur
authors.initials: A
authors.lastname: Engin
authors.affiliation: Department of Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Mert Ahmet
authors.initials: MA
authors.lastname: Kuskucu
authors.affiliation: Department of Biochemistry, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.
authors.forename: Sevtap
authors.initials: S
authors.lastname: Bakir
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.
authors.forename: Omür
authors.initials: O
authors.lastname: Gündag
authors.affiliation: Department of Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Kenan
authors.initials: K
authors.lastname: Midilli
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003289:Convalescence; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D003225:Hemorrhagic Fever Virus, Crimean-Congo / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology*; D006479:Hemorrhagic Fever, Crimean / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D060888:Real-Time Polymerase Chain Reaction; D012720:Severity of Illness Index; D019562:Viral Load
chemical_list: D015415:Biomarkers; D004279:DNA, Viral
keywords: Crimean-Congo hemorrhagic fever; cell-free DNA; mortality; prognosis