Results
Of the 96 CCHF patients in our study, 58 (60.4%) were men and 38 (39.6%) were women. The median age of the study population was 50 years with an IQR of 35.3-61.0 years. The clinical symptoms are shown in Table 1. The most common symptoms were malaise, fever, and myalgia/arthralgia, respectively.
The patients’ laboratory findings are shown in Tables 2. There were statistically significantly differences in serum platelet, aspartate transaminase (AST), alanine transaminase (ALT), creatinine kinase (CK), lactate dehydrogenase (LDH), potassium, C-reactive protein (CRP), sedimentation, D-dimer, activated partial thromboplastin time (aPTT), ferritin, procalcitonin and lactate levels, and platelet/lymphocyte ratio (PLR) among the patients with mild, moderate and severe disease (p=0.017 for potassium and p=0.001 for rest of others).
Post-hoc pairwise comparison of laboratory findings according to the disease severity is shown in Table 3. PLR was significantly lower in patients with severe and moderate disease compared to those with mild disease (p<0.001 and p<0.001, respectively). Serum CRP level was statistically significantly higher in patients with severe disease compared to those with moderate disease and with mild disease (p=0.049 and p<0.001, respectively), and also there was statistically significant difference in serum CRP level among the patients with moderate disease and with mild disease (p=0.024). Serum D-dimer level was statistically significantly higher in patients with severe disease compared to those with mild disease (p=0.002). Ferritin level was significantly higher in patients with severe disease compared to those with moderate disease and those with mild disease (p<0.001 and p<0.001, respectively). Serum procalcitonin level was statistically significantly higher in patients with severe disease compared to those with moderate disease and with mild disease (p=0.001 and p<0.001, respectively), and also there was statistically significant difference in serum procalcitonin level among the patients with moderate disease and with mild disease (p=0.005). Serum lactate level was statistically significantly higher in patients with severe disease compared to those with moderate disease and with mild disease (p=0.004 and p<0.001, respectively).
For serum procalcitonin and lactate levels in differentiating severe and moderate/mild disease, the areas under ROC curves (AUCs) were 0.892 and 0.802, and the best cut-off points were >0.61 and >1.9, respectively. According to these cut-off values, the sensitivity and specificity of procalcitonin were 83.3% and 89.7%, and the sensitivity and specificity of lactate were 77.8% and 76.9%, respectively (Table 4 and Figure 1).
There were statistically significantly medium positive correlations between serum procalcitonin level and serum AST (R=0.584, p<0.001), ALT (R=0.497, p<0.001) and lactate (R=0.441, p<0.001) levels. Serum lactate level was also positively correlated with serum AST (R=0.459, p<0.001) and ALT (r=0.446, p<0.001) levels (Table 5 and Figure 2).