Clinical Microbiology and Infectious Diseases Clinic, Ankara Numune Education and Research Hospital, Ankara.
Clin Infect Dis. 2013 Nov;57(9):1270-4. doi: 10.1093/cid/cit527. Epub 2013 Aug 14.
Patients infected with Crimean-Congo hemorrhagic fever (CCHF) virus present with a wide clinical spectrum. In observational studies, the effects of therapeutic agents are confounded by severity. We describe use of a clinical severity scoring index (SSI) for CCHF patients and assess the effect of ribavirin and corticosteroid therapy on the case-fatality rate, stratified by SSI.
The study group included hospitalized patients who received a diagnosis of CCHF at the Infectious Diseases and Clinical Microbiology Clinic of Ankara Numune Education and Research Hospital between 2004 and 2011. The SSI included platelet count, bleeding, fibrinogen level, activated partial thromboplastin time, and somnolence. The effects of ribavirin and corticosteroid on the case-fatality rate were studied by univariate and multivariate analysis, stratified by SSI.
Two hundred eighty-one confirmed cases of CCHF were included in the study. Of 281 patients, 23 (8%) died. The mean age (±SD) of the patients was 47 ± 16 years. Forty-nine percent were female. The mean duration of stay at our clinic after onset of symptoms was 4.4 days, with a range of 1-14 days. In multivariate analysis of factors for the prediction of death, the SSI (odds ratio [OR], 3.27; 95% confidence interval [CI], 2.09-5.13) and ribavirin use (OR, 0.04; 95% CI, .004-.48) were found to be statistically significant factors.
The SSI is an accurate predictor of death and will therefore be a useful tool for case management and for drug-assessment studies. After stratification of cases by SSI, ribavirin was found to be effective in reducing the case-fatality rate, especially among moderately ill patients, whereas steroids were found to be beneficial particularly among patients with severe disease.
感染克里米亚-刚果出血热（CCHF）病毒的患者表现出广泛的临床谱。在观察性研究中，治疗药物的效果受到严重程度的影响。我们描述了一种用于 CCHF 患者的临床严重程度评分指数（SSI），并评估了利巴韦林和皮质类固醇治疗对病死率的影响，按 SSI 分层。
研究组包括 2004 年至 2011 年期间在安卡拉努姆恩教育和研究医院传染病和临床微生物学诊所住院的确诊为 CCHF 的患者。SSI 包括血小板计数、出血、纤维蛋白原水平、活化部分凝血活酶时间和嗜睡。通过单变量和多变量分析，按 SSI 分层，研究利巴韦林和皮质类固醇对病死率的影响。
研究纳入了 281 例确诊的 CCHF 病例。281 例患者中，23 例（8%）死亡。患者的平均年龄（±标准差）为 47±16 岁。49%为女性。从症状出现到我们诊所就诊的平均时间为 4.4 天，范围为 1-14 天。在死亡预测的多变量分析中，SSI（比值比[OR]，3.27；95%置信区间[CI]，2.09-5.13）和利巴韦林的使用（OR，0.04；95%CI，.004-.48）被发现是统计学上显著的因素。
SSI 是死亡的准确预测因子，因此将成为病例管理和药物评估研究的有用工具。按 SSI 分层病例后，发现利巴韦林可有效降低病死率，尤其是在中度疾病患者中，而皮质类固醇在严重疾病患者中则有益。
