Hatipoglu Cigdem Ataman, Bulut Cemal, Yetkin Meltem Arzu, Ertem Gunay Tuncer, Erdinc Fatma Sebnem, Kilic Esra Kaya, Sari Tugba, Kinikli Sami, Oral Behic, Demiroz Ali Pekcan
Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey.
Scand J Infect Dis. 2010 Jul;42(6-7):516-21. doi: 10.3109/00365540903582418.
The fatality rate of Crimean-Congo haemorrhagic fever (CCHF) disease has been reported as 5.4-80%. In this prospective study our aim was to evaluate the clinical and laboratory predictors of fatality in patients with CCHF. Among probable CCHF patients admitted to our clinic between 2005 and 2008, patients with positive IgM antibodies and/or polymerase chain reaction for CCHF virus were included in the study. To determine the predictors of fatality, we compared epidemiological, clinical and laboratory findings of the fatal cases with survivors. Ninety-three confirmed CCHF patients were included in the study; 56 (60.2%) of them were female. Mean patient age was 48.4+/-17.7 y and mean hospital stay was 7.9+/-3.0 days. Five patients died (5.4%). The rates of haemorrhage, diarrhoea and confusion were higher in fatal cases compared with non-fatal cases (p<0.05). Aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, lactate dehydrogenase (LDH), and C-reactive protein levels were higher in fatal cases; the international normalized ratio (INR) and activated partial thromboplastin time (aPTT) were longer and mean platelet counts were lower (p<0.05). By multivariate analysis, diarrhoea, melena, haematemesis, haematuria, elevated ALT and LDH, and prolongation of aPTT were independent clinical and laboratory predictors associated with fatality. We suggest that for patients who have diarrhoea, melena, haematemesis, haematuria, elevated AST and LDH, and a prolonged aPTT, physicians should be aware of the high fatality risk.
据报道，克里米亚-刚果出血热（CCHF）疾病的病死率为5.4%-80%。在这项前瞻性研究中，我们的目的是评估CCHF患者死亡的临床和实验室预测因素。在2005年至2008年期间入住我们诊所的疑似CCHF患者中，IgM抗体和/或CCHF病毒聚合酶链反应呈阳性的患者被纳入研究。为了确定死亡的预测因素，我们比较了死亡病例与幸存者的流行病学、临床和实验室检查结果。93例确诊的CCHF患者被纳入研究；其中56例（60.2%）为女性。患者平均年龄为48.4±17.7岁，平均住院时间为7.9±3.0天。5例患者死亡（5.4%）。与非死亡病例相比，死亡病例的出血、腹泻和意识障碍发生率更高（p<0.05）。死亡病例的天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、碱性磷酸酶、乳酸脱氢酶（LDH）和C反应蛋白水平更高；国际标准化比值（INR）和活化部分凝血活酶时间（aPTT）更长，平均血小板计数更低（p<0.05）。多因素分析显示，腹泻、黑便、呕血、血尿、ALT和LDH升高以及aPTT延长是与死亡相关的独立临床和实验室预测因素。我们建议，对于出现腹泻、黑便、呕血、血尿、AST和LDH升高以及aPTT延长的患者，医生应意识到其高死亡风险。
