Crucial Parameter of the Outcome in Crimean Congo Hemorrhagic Fever: Viral Load
Methods: A total of 126 patients that were treated in our clinic with diagnosis of CCHF between 2008 and 2013 were included in the study. Routine laboratory parameters were taken from hospital records whereas measurement of CCHF viral load were performed from serum samples conserved at -80°C with Real Time PCR.
Results: In our study, mortality rate was 11.1%. The most important prognostic factor was found to be viral load with a mean of 8,3x107 copy/ml in patients who survived and 4,6x109 copy/ml in patients who died. As viral load increases PT and aPTT times significantly extend; INR, AST, ALT, CPK, LDH, and creatinine levels rise and the probability of bleeding and seizure significantly increase. Any of the patients who had viral load greater than 2x109 copy/ml survived.
When cut-off value that can estimate the prognosis is calculated, probability of survival is found to be significantly reduced where viral load > 1.03x 108 copy/ml. Patients were categorized according to their viral load with a cut-off value of 108 copy/ml. While no significant differences were found for frequency of fever, myalgia, nausea and vomiting and abdominal pain; patients with 108 copy/ml or higher viral load had diarrhea, headache and unconsciousness significantly more frequently. Among clinical findings; bleeding, seizure and haemodialysis were significantly more frequent in patients with viral load 108 copy/ml or higher (p<0.05). WBC, haemoglobin, and platelet counts were significantly lower in patients who had 108 copy/ml or higher viral load whereas AST, ALT, CPK, LDH, creatinine levels, PT and aPTT time, D-dimer levels and INR were found to be significantly higher among same patients. All blood product transfusions were significantly used more in patients who had viral load > 108 copy/ml.
Conclusion: Our study has the largest number of patients among studies which evaluate viral load on CCHF. As in all other studies, our study shows that viral load is the most effective parameter on mortality and as viral load increases survival rate significantly decreases.
A. Carhan, None
Z. Kocak Tufan, None
D. Yagci Caglayik, None
G. R. Yilmaz, None
T. Guven, None
M. A. Tasyaran, None