Crimean-Congo haemorrhagic fever outcome forecasting

Abstract

Background: During providing medical care to seriously ill patients with Crimean-Congo hemorrhagic fever (CCHF), the risk of health care-associated infections (HCAIs) increases in first and second level hospitals. A unified assessment of the severity of the patient's condition which allow to identify the patients at high risk of death and indications for transfer to a third-level hospital is required. Aim: to develop a methodology for assessment the risk of death in patients with CCHF based on the clinical and laboratory parameters at the day of hospitalization, which are available in the hospitals of first/second level. Methods & Materials: Based on the analysis of 4 methods of assessment the severity of patients with CCHF (Swanepoel et al., 1989; Bakir et al., 2012; Dokuzoguz, 2013; Bakir et al., 2015) a mortality risk prediction scale was developed. It based on 12 clinical and laboratory parameters (age, alanine transaminase, aspartate transaminase, leukocyte count, liver size, organ disorders, bleeding, thrombocyte count, prothrombin time, international normalized ratio, fibrinogen) and 2–4 gradations of each parameter, which were reflected in 32 criteria of the scale. The scale was tested on the retrospective analysis of case records of 52 patients with CCHF who were treated in hospitals of the Turkestan region in Kazakhstan in 2000–2018. Results: Clinical and laboratory parameters of the patients were evaluated in accordance with the developed point scale for assessing the risk of death in patients with CCHF. Each evaluated parameter was assigned a certain number of points and their total amount was determined. With a patient score of ≥11, a high probability of an adverse outcome was predicted. With a score of <11, the probability of an fatal outcome of CCHF was estimated as low. The sensitivity of the proposed method is 100%, specificity – 98%, predicted value – 90%. Conclusion: The proposed methodology with a high probability allows to predict the development of an unfavorable outcome of CCHF and is suitable for use in hospitals of the first and second levels to optimize the medical care of patients with this pathology and the prevent of HAIs.