Cevik Mustafa A, Erbay Ayse, Bodur Hürrem, Gülderen Evrim, Baştuğ Aliye, Kubar Ayhan, Akinci Esragül
Infectious Diseases and Clinical Microbiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey.
Int J Infect Dis. 2008 Jul;12(4):374-9. doi: 10.1016/j.ijid.2007.09.010. Epub 2007 Dec 11.
To determine the predictors of fatality among patients with Crimean-Congo hemorrhagic fever (CCHF) based on epidemiological, clinical, and laboratory findings.
Among the patients with possible CCHF who were referred to Ankara Numune Education and Research Hospital (ANERH) from the surrounding hospitals between 2003 and 2006, those with IgM antibodies and/or reverse transcriptase-polymerase chain reaction (RT-PCR) results positive for CCHF virus in their blood, and who had received only supportive treatment, were included in the study.
Sixty-nine patients with CCHF were admitted to ANERH from various cities of the northeastern part of the central region and southern parts of the Black Sea region of Turkey. Eleven (15.9%) patients died. Age, gender, days from the appearance of symptoms to admission, and initial complaints except bleeding were similar between fatal and non-fatal cases (p>0.05). Among the clinical findings, ecchymosis (p=0.007), hematemesis (p=0.030), melena (p<0.001), somnolence (p<0.001), and gingival bleeding (p=0.044) were more common among fatal cases. The mean platelet count was 47.569 x 10(9)/l in non-fatal cases and 12.636 x 10(9)/l in fatal cases (p=0.003). Among the fatal cases, the mean prothrombin time (PT; 18.4s vs. 13.4s; p<0.001) and the mean activated partial thromboplastin time (aPTT; 69.4s vs. 42.7s; p=0.001) were longer, and the mean alanine aminotransferase (ALT; 1688 vs. 293; p<0.001), mean aspartate aminotransferase (AST; 3028 vs. 634; p<0.001), mean lactate dehydrogenase (LDH; 4245 vs. 1141; p<0.001), mean creatine phosphokinase (CPK; 3016 vs. 851; p=0.004) levels and the mean international normalized ratio (INR; 1.38 vs. 1.1; p<0.001) were higher. In a Cox proportional hazards model, thrombocytopenia of < or = 20 x 10(9)/l (hazard rate (HR) 9.67; 95% confidence interval (CI) 1.16-80.68; p=0.036), a prolonged aPTT > or = 60s (HR 11.62; 95% CI 2.40-56.27; p=0.002), existence of melena (HR 6.39; 95% CI 1.64-24.93; p=0.008), and somnolence (HR 6.30; 95% CI 1.80-22.09; p=0.004) were independently associated with mortality.
Thrombocytopenia of < or = 20 x 10(9)/l, a prolonged aPTT > or = 60s, the existence of melena, and somnolence were independent predictors of fatality.
根据流行病学、临床和实验室检查结果，确定克里米亚-刚果出血热（CCHF）患者死亡的预测因素。
2003年至2006年间，从周边医院转诊至安卡拉努穆内教育和研究医院（ANERH）的疑似CCHF患者中，那些血液中IgM抗体和/或逆转录聚合酶链反应（RT-PCR）结果显示CCHF病毒呈阳性，且仅接受支持治疗的患者被纳入研究。
69例CCHF患者从土耳其中部地区东北部和黑海地区南部的不同城市被收治到ANERH。11例（15.9%）患者死亡。致命和非致命病例在年龄、性别、症状出现至入院天数以及除出血外的初始症状方面相似（p>0.05）。在临床检查结果中，瘀斑（p=0.007）、呕血（p=0.030）、黑便（p<0.001）、嗜睡（p<0.001）和牙龈出血（p=0.044）在致命病例中更为常见。非致命病例的平均血小板计数为47.569×10⁹/L，致命病例为12.636×10⁹/L（p=0.003）。在致命病例中，平均凝血酶原时间（PT；18.4秒对13.4秒；p<0.001）和平均活化部分凝血活酶时间（aPTT；69.4秒对42.7秒；p=0.001）更长，平均丙氨酸氨基转移酶（ALT；1688对293；p<0.001）、平均天冬氨酸氨基转移酶（AST；3028对634；p<0.001）、平均乳酸脱氢酶（LDH；4245对1141；p<0.001）、平均肌酸磷酸激酶（CPK；3016对851；p=0.004）水平以及平均国际标准化比值（INR；1.38对1.1；p<0.001）更高。在Cox比例风险模型中，血小板减少≤20×10⁹/L（风险比（HR）9.67；95%置信区间（CI）1.16 - 80.68；p=0.036）、aPTT延长≥60秒（HR 11.62；95%CI 2.40 - 56.27；p=0.002）、存在黑便（HR 6.39；95%CI 1.64 - 24.93；p=0.008）和嗜睡（HR 6.30；95%CI 1.80 - 22.09；p=0.004）与死亡率独立相关。
血小板减少≤20×10⁹/L、aPTT延长≥60秒、存在黑便和嗜睡是死亡的独立预测因素。
