Association of Mortality with Leukocyte Distribution in Crimean-Congo Hemorrhagic Fever: Twelve Years Experience in A Retrospective Case Control Study
Crimean-Congo hemorrhagic fever (CCHF) is a life threatening illness. In this study we aimed to detect the effect of the leukocyte, lymphocyte and monocyte levels on the survival. To our knowledge this is first study analyzing the relationship between mortality and leukocyte distrubition.
A total of 220 patients were evaluated between 2002 and 2013 years retrospectively. Demographic, clinic and laboratory parameters of the fatal and non-fatal patients were compared statistically.
The mean age of the patients was 50.21±17.07 years (15-85) and the mortality rate was 16.4%. The most frequent symptoms were fever (88.2%), lack of appetite (79. %) and myalgia (75%). Of the 220 patients 29.5% had hemorrhages and 11.4% had somnolence. Most of the patients (75%) were working in animal husbandry and 63.6% had tick bite history. Mean duration of symptoms after tick bite was 3.87±3.06 days. Mean hospitalization time (6.42±3.06 days) was significantly shorter in fatal cases (p<0.001). Univariate analysis revealed that hemorrhages (66,7 %), somnolence (47.2%), petechia 36.1% and ecchymoses 38.9% were significantly higher in fatal cases (p<0.001). In multivariate analysis; somnolence, hemorrhages and diarrhea were independent factors for mortality (OR:36.5, OR:12.4 and OR: 5.9, respectively). In comparison of the first and third admission-day laboratory values, increase of leukocytes (WBC), lymphocytes and monocytes were significant in non-fatal cases (p<0.001). ROC curve analysis revealed that if the first day WBC count was ≥ 2950/mm3, mortality rate could be predicted with 62.1% sensitivity and 33.1% specifity. In consideration of mean hospitalisation length in fatal cases (4.3 days), third-admission day leukocyte distributions were analyzed between the two groups. It was found that, increases of the neutrophils and decreases of the monocytes were independent risk factors in mortality. Although decreases of lymphocytes were significant in univariate analysis, there was no difference in multivariate analysis.
Conclusion: The depletion of monocyte and lymphocyte counts and the increase of neutrophils were correlated with poor outcome. This result suggests the importance of mononuclear immune response for survival in CCHF.
S. Kazancioglu, None
H. Aslaner, None
A. But, None
E. Akinci, None
M. A. Yetkin, None
S. Eren, None
H. Bodur, None