Department of Emergency Medicine, Faculty of Medicine, Hitit University, 19040 Çorum, Turkey.
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hitit University, 19040 Çorum, Turkey.
Medicina (Kaunas). 2023 Oct 9;59(10):1796. doi: 10.3390/medicina59101796.
: Crimean-Congo Hemorrhagic Fever (CCHF) is a viral zoonotic infection, which is seen over a wide geographic area. The mortality rate is in inverse proportion to the ability of patients to access healthcare services. Therefore, early identification of patients is extremely important. The aim of this study was to test the sensitivity and specificity of the Hitit Index in the differentiation of CCHF cases at the time of presentation at the Emergency Department and to evaluate the agreement of this index with molecular (CCHFV RNA) and/or serological diagnostic tests (ELISA-CCHF IgM). The patients included were those who presented at the Emergency Department (ED) with the complaint of a tick bite or those identified as potential CCHF cases as a result of complaints and/or laboratory findings. For cases that met the study inclusion criteria, the Hitit Index score was calculated automatically from the parameters included in the index formula uploaded to the automation system in the ED at the time of presentation. Through comparisons of the agreement of the Hitit Index with the CCHFV-RNA and/or IgM results the power of the Hitit Index for differentiation of CCHF cases in ED was evaluated. The data of 273 patients were analyzed. There was a history of tick bite in 236 (86%) cases. Of the evaluated cases, 110 (40.2%) were hospitalized; CCHF positivity was determined in 72 (26.4%). The Hitit Index values calculated in ED and at 24 h after hospitalization were determined to be significant in the prediction of the CCHF cases ( < 0.001, AUC = 0.919 (0.887-0.951); < 0.001, AUC = 0.902 (0.841-0.962). For a cut-off point of 0 of the Hitit Index evaluated in ED, the classification success was found to have a sensitivity of 75% and specificity of 88% (PPV-NPV). For a cut-off point of 0 of the Hitit Index evaluated at 24 h after hospitalization, the classification success was found to have a sensitivity of 79.7% and specificity of 84% (PPV-NPV). The defined form of the Hitit Index can be used in the differentiation of CCHF cases in ED with high sensitivity and specificity levels. Just as evaluation with the Hitit Index prevents unnecessary hospitalization, it can also contribute to reducing mortality rates with the early identification of CCHF cases.
克里米亚-刚果出血热（CCHF）是一种病毒性人畜共患病感染，在广泛的地理区域内可见。死亡率与患者获得医疗保健服务的能力成反比。因此，早期识别患者至关重要。本研究的目的是测试 Hitit 指数在急诊科就诊时区分 CCHF 病例的敏感性和特异性，并评估该指数与分子（CCHFV RNA）和/或血清学诊断检测（ELISA-CCHF IgM）的一致性。纳入的患者为因蜱叮咬而在急诊科就诊的患者，或因症状和/或实验室发现而被确定为潜在 CCHF 病例的患者。对于符合研究纳入标准的病例，在急诊科就诊时，自动从上传到自动化系统的指数公式中包含的参数计算 Hitit 指数得分。通过比较 Hitit 指数与 CCHFV-RNA 和/或 IgM 结果的一致性，评估 Hitit 指数在急诊科区分 CCHF 病例的能力。对 273 例患者的数据进行了分析。236 例（86%）患者有蜱叮咬史。在所评估的病例中，110 例（40.2%）住院；确定 72 例（26.4%）为 CCHF 阳性。在急诊科和住院后 24 小时计算的 Hitit 指数值被确定为预测 CCHF 病例的重要指标（<0.001，AUC=0.919（0.887-0.951）；<0.001，AUC=0.902（0.841-0.962）。对于在急诊科评估的 Hitit 指数为 0 的截止点，分类成功率的敏感性为 75%，特异性为 88%（PPV-NPV）。对于住院后 24 小时评估的 Hitit 指数为 0 的截止点，分类成功率的敏感性为 79.7%，特异性为 84%（PPV-NPV）。定义形式的 Hitit 指数可用于在急诊科以高敏感性和特异性水平区分 CCHF 病例。正如使用 Hitit 指数评估可以防止不必要的住院治疗一样，它还可以通过早期识别 CCHF 病例来降低死亡率。
