Analysis of risk-factors among patients with Crimean-Congo haemorrhagic fever virus infection: severity criteria revisited
Analysis of risk-factors among patients with Crimean-Congo haemorrhagic fever virus infection: severity criteria revisited
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DOI：
10.1111/j.1469-0691.2006.01445.x
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发表时间：
2006-06-01
影响因子：
14.2
通讯作者：
Dokuzoguz, B.
中科院分区：
文献类型：
--
作者：
Ergonul, O.;Celikbas, A.;Dokuzoguz, B.
本研究的目的是确定克里米亚-刚果出血热（CCHF）病毒感染患者死亡率的预测因素。在2002-2004年春季和夏季入院的急性发热综合征患者中，以不适、出血、白细胞减少和血小板减少为特征，54例血液或组织中CCHF病毒IgM和/或PCR结果阳性。总病死率为7.4%。在死亡病例中，（p 0.009），黑粪症（p 0.001）和嗜睡（p 0.022）更常见，血小板计数中位数显着较低（10 600/mL vs. 20 000/mL; p 0.038），平均凝血酶原时间（27 s vs. 16 s; p 0.002）和平均活化部分凝血活酶时间（73 s vs. 44 s; p < 0.001）较长，平均丙氨酸转移酶（ALT）水平（1125 vs. 331; p < 0.001），平均天冬氨酸转移酶（AST）水平（3118 vs. 913; p 0.004）和平均纤维蛋白原水平（119 vs. 340; p 0.012）较高。血清IgM和IgG抗CCHF病毒检测，分别为25%和0%，致命的情况下，与94%和62%，分别为有利的结果。22例（41%）患者口服利巴韦林。在4例死亡病例中，本打算给3名患者开利巴韦林，但由于呕血和黑粪症，这是不可能的。建议使用较高水平的AST（>= 700 U/L）和ALT（>= 900 U/L）作为严重性标准。口服利巴韦林对呕血患者无效，静脉注射利巴韦林是治疗慢性充血性心力衰竭的必要手段。
The aim of this study was to determine the predictors of mortality among patients infected with Crimean-Congo haemorrhagic fever (CCHF) virus. Among patients with acute febrile syndrome, characterised by malaise, bleeding, leukopenia and thrombocytopenia, who were admitted to hospital during the spring and summer of 2002-2004, 54 had positive IgM and/or PCR results for CCHF virus in blood or tissue. The overall case fatality rate was 7.4%. Among the fatalities, haematemesis (p 0.009), melaena (p 0.001) and somnolence (p 0.022) were more common, the median platelet count was significantly lower (10 600/mL vs. 20 000/mL; p 0.038), the mean prothrombin time (27 s vs. 16 s; p 0.002) and mean activated partial thromboplastin time (73 s vs. 44 s; p < 0.001) were longer, and the mean alanine transferase (ALT) level (1125 vs. 331; p < 0.001), the mean aspartate transferase (AST) level (3118 vs. 913; p 0.004) and the mean fibrinogen level (119 vs. 340; p 0.012) were higher. Serum IgM and IgG against CCHF virus was detected in 25% and 0%, respectively, of fatal cases, compared with 94% and 62%, respectively, of cases with favourable outcomes. Oral ribavirin was prescribed to 22 (41%) patients. Of the four fatal cases, it was the intention to prescribe ribavirin to three patients, but this was not possible because of haematemesis and melaena. Higher levels of AST (>= 700 U/L) and ALT (>= 900 U/L) are suggested for use as severity criteria. Oral ribavirin was not effective for patients with haematemesis, and intravenous ribavirin is necessary for treatment of CCHF.