血清铁蛋白水平能否预测克里米亚-刚果出血热患者的疾病严重程度？

Can serum ferritin level predict disease severity in patients with crimean-congo hemorrhagic Fever?

作者信息

Metanat Maliheh, Sharifi-Mood Batool, Tabatabaei Mehdi, Sarraf-Shirazi Mohammad

机构信息

Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.

出版信息

Eurasian J Med. 2013 Jun;45(2):108-14. doi: 10.5152/eajm.2013.22.

DOI:10.5152/eajm.2013.22

PMID:25610262

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4261482/

Abstract

OBJECTIVE

Crimean-Congo hemorrhagic fever (CCHF) is an acute viral disease. Several factors have already been suggested to explain the pathogenesis as well as predict the disease severity. In our study we aim to investigate the role of serum ferritin level as a possible predicting factor of disease severity in these patients.

MATERIALS AND METHODS

We evaluated all patients with laboratory confirmed diagnosis of CCHF who were admitted to Boo-Ali Hospital of Zahedan from May 2011 to June 2012. Confirmation of the disease determined using the presence of anti- CCHFV IgM in the serum by enzyme-linked immunosorbent assay (ELISA) or by polymerase chain reaction(PCR). After ethical approval, patients were categorized into two groups of mild and severe disease according to disseminated intravascular coagulation (DIC) severity using the scoring system of International Society on Thrombosis and Hemostasis (ISTH). Serum ferritin levels were evaluated and compared between these two groups. Receiver operating characteristic (ROC) curve analysis was performed to assess the optimal cutoff value of serum ferritin for predicting the disease severity.

RESULTS

A total of 42 patients (36 men, 6 women, age range: 17-78 years) were included in this study, of whom 38% had Persian and 62% had Baloch ethnicity. According to DIC severity score, 54.7% of the patients had severe disease and 45.3% had mild disease. The area under the ROC curve was 0.896 and 95% CI was 0.801-0.991 (p<0.0001). A cut-off point of 1060 ng/dL, had a sensitivity of 78.9%, a specificity of 87%, a positive predictive value of 6% and a negative predictive value of 100%. Positive and negative likelihood ratios for this serum ferritin level were 6.05 and 0.24, respectively.

CONCLUSION

Increased serum ferritin level has a significant positive correlation with disease severity in patients with CCHF and can evaluate the prognosis of these patients with a high sensitivity and specificity.

摘要

目的

克里米亚-刚果出血热（CCHF）是一种急性病毒性疾病。已经提出了几个因素来解释其发病机制以及预测疾病严重程度。在我们的研究中，我们旨在调查血清铁蛋白水平作为这些患者疾病严重程度可能的预测因素的作用。

材料与方法

我们评估了2011年5月至2012年6月期间入住扎黑丹布阿里医院的所有实验室确诊为CCHF的患者。通过酶联免疫吸附测定（ELISA）或聚合酶链反应（PCR）检测血清中抗CCHFV IgM的存在来确定疾病诊断。经伦理批准后，根据国际血栓与止血学会（ISTH）的评分系统，根据弥散性血管内凝血（DIC）严重程度将患者分为轻症和重症两组。评估并比较这两组患者的血清铁蛋白水平。进行受试者操作特征（ROC）曲线分析以评估血清铁蛋白预测疾病严重程度的最佳临界值。

结果

本研究共纳入42例患者（36例男性，6例女性，年龄范围：17 - 78岁），其中38%为波斯族，62%为俾路支族。根据DIC严重程度评分，54.7%的患者为重症，45.3%的患者为轻症。ROC曲线下面积为0.896，95%置信区间为0.801 - 0.991（p<0.0001）。临界值为1060 ng/dL时，灵敏度为78.9%，特异性为87%，阳性预测值为6%，阴性预测值为100%。该血清铁蛋白水平的阳性和阴性似然比分别为6.05和0.24。