Crucial parameter of the outcome in Crimean Congo hemorrhagic fever: Viral load

•Viral load is the most effective parameter on mortality in CCHF.•Probability of survival significantly reduces where viral load >1.03 × 108 copy/ml.•We introduce creatinine >1.4 mg/dl as a new mortality indicator in CCHF.

BackgroundCrimean Congo hemorrhagic fever (CCHF) is a fatal disease with a mortality rate of 5–30%. CCHF can be asymptomatic or it may progress with bleeding and cause mortality.ObjectivesTo evaluate relation of viral load with mortality, clinical and laboratory findings in CCHF.Study designA total of 126 CCHF patients were included. Serum samples obtained from all patients on admission for measurement of viral load.ResultsIn our study, mortality rate was 11.1%. The most important prognostic factor was viral load. Mean viral load was 8.3 × 107 copy/ml and 4.6 × 109 copy/ml in survived and dead patients, respectively (p < 0.005). Probability of survival is found to be significantly reduced where AST >1130 U/l, ALT >490 U/l, CPK >505 U/l, LDH >980 U/l, platelet count <23 × 103/l, creatinine >1.4 mg/dl, INR >1.3, d-dimer >7100 ng/dl, and viral load >1.03 × 108 copy/ml. Patients with 108 copy/ml or higher viral load had diarrhea, headache, unconsciousness, bleeding, and seizure significantly more frequently (p < 0.05). WBC, hemoglobin, platelet counts were significantly lower whereas AST, ALT, CPK, LDH, creatinine levels, PT and aPTT time, d-dimer levels, and INR were found to be significantly higher in these group.ConclusionsThere are several severity criteria for prognosis of CCHF. In addition to these parameters, we introduce creatinine as a predictive factor for prognosis. Our study, which has the largest number of patients among studies that evaluate viral load on CCHF shows that viral load is the most effective parameter on mortality.