Clinical and laboratory features of Crimean-Congo haemorrhagic fever: predictors of fatality
Abstract number: 1733_538
Cevik M.A., Erbay A., Bodur H., Gulderen E., Bastug A., Kubar A., Akinci E.
Objectives: To determine the predictors of fatality among patients with Crimean-Congo haemorrhagic fever (CCHF) based on epidemiological, clinical and laboratory findings.
Methods: Among the patients who were referred from surrounding hospitals to Ankara Numune Education and Research Hospital as a possible CCHF case during the spring and summer of 20032006, patients with IgM antibodies or PCR results positive for CCHF virus in blood and who had received only supportive treatment were included to the study.
Results: Sixty-nine patients were admitted from various cities of north-east of central Anatolia and the southern parts of the Black Sea region. Male patients accounted for 45 (65%) of the patients and the mean age was 50 years. Eleven (15.9%) cases were died with massive haemorrhage. The age, gender, days from the appearance of symptoms to admission and initial complaints were similar between fatal and survived cases (p > 0.05). Forty patients were IgM-positive, and 50 patients were PCR-positive. Among the clinical findings, ecchymosis (p = 0.007), hematoma (p = 0.023), haematemesis (p = 0.030), melaena (p < 0.001) and somnolence (p < 0.001) were more common among fatal cases. Almost all of the patients had leukopenia, thrombocytopenia, and elevated AST, ALT, LDH and CPK levels at admission. Mean thrombocyte level was 47000/mm3 in survived patients and 12000/mm3 in died patients (p = 0.003). Among the fatal cases the mean PT (18 s vs. 13 s; p < 0.001) and mean aPTT were longer (69 s vs. 43 s; p = 0.001), the mean ALT (1688 vs. 293; p < 0.001) and the mean AST (3028 vs. 634; p < 0.001) were higher. All patients received intensive clinical supportive measures, including platelets, fresh frozen plasma, and packed erythrocyte infusions, when indicated. None of the patients received ribavirin. Fatal patients received significantly more fresh frozen plasma (p < 0.001) and thrombocyte suspensions (p = 0.017) than survived patients. Cox proportional hazard model was used for fatality analysis, the starting time point was beginning of the complaints, and the ending time point was either death or discharge from the hospital. Thrombocytopenia of <20000/mm3 (hazard rate [HR], 9.8; 95% confidence interval [CI], 1.1781.4; p = 0.035) and somnolence (HR, 5; 95% CI, 1.417.5; p = 0.012) were independently associated with mortality.
Conclusion: Thrombocytopenia of <20000/mm3 and somnolence were independent predictors of fatality among patients with CCHF.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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