Can Serum Ferritin Level Predict Disease Severity in Patients with Crimean-Congo Hemorrhagic Fever?

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.Key Words: Crimean-Congo hemorrhagic fever, disease severity, ferritin Bulgular:Toplam 42 hasta (36 erkek, 6 kadın, yaş aralığı: 17-78 yıl olmak üzere) bu çalışmaya dahil edilmiştir, hastaların %38 Pers ve %62 Baloch etnik grubuna dahildir. DIC şiddet skoruna göre, hastaların %54.7 ciddi ve %45.3 'ü hafif olarak sınıflandırılmıştır. ROC eğrisi altında kalan alan 0.896 ve %95 CI 0.801-0.991 (p değeri <0.05) bulunmuştur. 1.060 ng/dL bir kesim noktası %78.9 bir duyarlılık, %87 özgüllük, %6 bir pozitif prediktif değer ve %100 bir negatif prediktif değer tespit edilmiştir. Bu serum ferritin düzeyi için pozitif ve negative olabilirlik oranları sırasıyla 6.05 ve 0.24 olarak bulunmuştur.Sonuç: Artmış serum ferritin düzeyi KKKA hastalarında hastalık şid-deti ile anlamlı pozitif korelasyona sahiptir ve bu hastalarda prognozu yüksek bir duyarlılık ve özgüllük ile gösterebilir.

Viral Load as a Predictor of Severity in Crimean-Congo Hemorrhagic Fever

“…Up to now, various parameters have been proposed to determine disease severity including platelet counts lower than 50000/ mm 3 , increased levels of PTT, PT, Liver transaminases, muscle enzyme, and viral load levels. However, researchers have a common agreement that severity of DIC, which occurs during CCHF, can be used as a prediction factor for disease severity (11,15,18). In the current study, three cases of fatal outcome occurred with initial platelet counts of 4000, 19000, and 10000/ mm The current research faced two main limitations.…”

“…Next, the patients were divided into two groups of severe and non-severe viral load based on DIC severity criteria. The DIC severity scoring was based on the International society on thrombosis and haemostasis (ISTH) (11,15). Descriptive statistics were used to present the data and various non-parametric tests such as Mann-Whitney U (2 samples), T-test, and ROC Curve were used to analyze the data.…”

“…The important factors related to mortality during the first five days of disease are mainly men-tioned as platelet count less than 20000/mm 3 , ALT ≥ 900 U/L, AST ≥ 700 U/L, PTT ≥ 60 sec, and fibrinogen count less than or equal to 110 mg/dL (10). In a study, it has been suggested the level of 1060 ng/dL ferritin serum (sensitivity of 78.9% and specificity of 87%) in order to differentiate between severe and non-severe cases based on the DIC index (11). In most studies, the coagulopathy (clotting disorders) parameters in patients with CCHF and its correlation with disease severity and mortality have been proven (11,12).…”

“…In a study, it has been suggested the level of 1060 ng/dL ferritin serum (sensitivity of 78.9% and specificity of 87%) in order to differentiate between severe and non-severe cases based on the DIC index (11). In most studies, the coagulopathy (clotting disorders) parameters in patients with CCHF and its correlation with disease severity and mortality have been proven (11,12). In a study conducted by Mardani et al (13), it was shown that patients stricken by low platelets, in particular those with platelets lower than 50000/mm 3 , are prone to high mortality rates.…”

“…Patient death occurs due to hypovolemic shock caused by severe bleeding, infection, or disseminated intravascular coagulation disorder (DIC) (9,13). Based on the clinical pathology of the disease, one of the main parameters proposed for CCHF intensity is the DIC severity that occurs amid CCHF disease (11 …”