title: Crucial parameter of the outcome in Crimean Congo hemorrhagic fever: Viral load.
abstract: BACKGROUND
  Crimean Congo hemorrhagic fever (CCHF) is a fatal disease with a mortality rate of 5-30%. CCHF can be asymptomatic or it may progress with bleeding and cause mortality.
  
  
  OBJECTIVE
  To evaluate relation of viral load with mortality, clinical and laboratory findings in CCHF.
  
  
  METHODS
  A total of 126 CCHF patients were included. Serum samples obtained from all patients on admission for measurement of viral load.
  
  
  RESULTS
  In our study, mortality rate was 11.1%. The most important prognostic factor was viral load. Mean viral load was 8.3×10(7)copy/ml and 4.6×10(9)copy/ml in survived and dead patients, respectively (p<0.005). Probability of survival is found to be significantly reduced where AST >1130U/l, ALT >490U/l, CPK >505U/l, LDH >980U/l, platelet count <23×10(3)/l, creatinine >1.4mg/dl, INR >1.3, d-dimer >7100ng/dl, and viral load >1.03×10(8)copy/ml. Patients with 10(8)copy/ml or higher viral load had diarrhea, headache, unconsciousness, bleeding, and seizure significantly more frequently (p<0.05). WBC, hemoglobin, platelet counts were significantly lower whereas AST, ALT, CPK, LDH, creatinine levels, PT and aPTT time, d-dimer levels, and INR were found to be significantly higher in these group.
  
  
  CONCLUSIONS
  There are several severity criteria for prognosis of CCHF. In addition to these parameters, we introduce creatinine as a predictive factor for prognosis. Our study, which has the largest number of patients among studies that evaluate viral load on CCHF shows that viral load is the most effective parameter on mortality.
authors.affiliation: Ankara Ataturk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Bilkent, Ankara, Turkey. Electronic address: imran.solak@gmail.com.
authors.forename: Imran
authors.initials: I
authors.lastname: Hasanoglu
authors.affiliation: Yildirim Beyazit University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bilkent, Ankara, Turkey. Electronic address: rahmetguner@yahoo.com.
authors.forename: Rahmet
authors.initials: R
authors.lastname: Guner
authors.affiliation: Department of Medical Biology, Yildirim Beyazit University School of Medicine, Ankara, Turkey. Electronic address: ahmet_carhan@hotmail.com.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Carhan
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Yildirim Beyazit University School of Medicine, Bilkent, Ankara, Turkey. Electronic address: drztufan@yahoo.com.
authors.forename: Zeliha
authors.initials: Z
authors.lastname: Kocak Tufan
authors.affiliation: National Arbovirus and Viral Zoonoses Reference and Research Laboratory, Public Health Institute of Turkey, Ankara, Turkey. Electronic address: dilekyagci@gmail.com.
authors.forename: Dilek
authors.initials: D
authors.lastname: Yagci-Caglayik
authors.affiliation: Yildirim Beyazit University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bilkent, Ankara, Turkey. Electronic address: tumerguven@yahoo.com.
authors.forename: Tumer
authors.initials: T
authors.lastname: Guven
authors.affiliation: Ankara Ataturk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Bilkent, Ankara, Turkey. Electronic address: ruhsar6@yahoo.com.
authors.forename: Gul Ruhsar
authors.initials: GR
authors.lastname: Yilmaz
authors.affiliation: Yildirim Beyazit University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bilkent, Ankara, Turkey. Electronic address: matasyaran@gmail.com.
authors.forename: Mehmet A
authors.initials: MA
authors.lastname: Tasyaran
mesh_terms: D000328:Adult; D015415:Biomarkers; D003404:Creatinine; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products; D003225:Hemorrhagic Fever Virus, Crimean-Congo; D006479:Hemorrhagic Fever, Crimean / Q000097:blood / Q000401:mortality* / Q000821:virology*; D006801:Humans; D008297:Male; D009026:Mortality; D010976:Platelet Count; D011379:Prognosis; D016019:Survival Analysis; D019562:Viral Load
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D003404:Creatinine
keywords: Creatinine; Crimean Congo hemorrhagic fever; Mortality; Prognosis; Viral load