Platelet-normalized biomarkers as diagnostic and prognostic indicators in crimean-congo hemorrhagic fever
Serkan Bolat1, Seyit Ali Buyuktuna21Department of Medical Biochemistry, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Türkiye2Department of Infectious Diseases and Clinical Microbiology, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Türkiye
INTRODUCTION: Crimean-congo hemorrhagic fever (CCHF) is a viral disease characterized by thrombocytopenia and systemic inflammation. In this study, we evaluated the role of platelet-normalizing biomarkers as diagnostic and prognostic indicators of CCHF.
METHODS: This study included 60 patients with CCHF and 30 age-/sex-matched healthy controls. Biochemical parameters, including aspartate aminotransferase, alanine aminotransferase (ALT), gamma-glutamyl transferase, alkaline phosphatase, C-reactive protein and interleukin-6 (IL-6) levels were measured using photometric or electrochemiluminescence methods (Roche Cobas 8000, c702 and e801). Coagulation parameters’ levels; activated partial thromboplastin time, international normalized ratio, fibrinogen, and D-dimer were determined using Roche Cobas t511. These parameters were expressed as ratios to platelet count (Plt). Comparisons were performed between the CCHF cohort and control group. Subgroup analyses evaluated associations with intensive care unit (ICU) admission and mortality risk.
RESULTS: Statistically signifcant diferences were observed between CCHF patients and healthy controls in all parameters (p<0.05). Patients admitted to the ICU or those who did not survive exhibited a significant increase in all platelet-normalized ratios (p<0.05), except ALT/Plt. ROC analysis revealed that IL-6/Plt (AUC=0.998, cut-off>0.018, sensitivity=98.3%, specificity=100%) and D-dimer/Plt (AUC=0.992, cut-off>0.002, sensitivity=95%, specificity=96.7%) had the highest diagnostic accuracy for CCHF. Furthermore, IL-6/Plt and D-dimer/Plt ratios also showed high predictive accuracy for predicting the need for ICU admission and mortality risk.
DISCUSSION AND CONCLUSION: Platelet-normalized biomarkers, particularly IL-6/Plt and D-dimer/Plt, demonstrate strong diagnostic and prognostic potential for CCHF. Their inclusion in clinical protocols could improve early detection, risk assessment and treatment decisions for CCHF patients.
Manuscript Language: English