Clinical and laboratory predictors of severe pediatric Crimean-Congo hemorrhagic fever: A retrospective study

Abstract

Objective: To identify clinical and laboratory parameters associated with severe disease requiring intensive care among pediatric Crimean-Congo hemorrhagic fever (CCHF) patients.

Methods: Twenty-three children with confirmed CCHF were divided into two groups: Pediatric intensive care unit (PICU) patients (n=12) and general ward patients (n=11). Laboratory parameters including platelet count, platelet mass index (PMI), liver enzymes, and inflammatory markers were analyzed at admission through univariate and multivariate logistic regression as well as receiver operating characteristic curve analysis.

Results: PICU patients had significant lower platelet counts and PMI (P=0.002 for both), and higher aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and ferritin levels (P<0.01). Univariate analysis identified platelet count (OR 0.99, P=0.026), PMI (OR 0.98, P=0.021), AST (OR 1.03, P=0.025), and alanine aminotransferase (OR 1.03, P=0.050) as significant predictors of PICU admission. Multivariate analysis demonstrated PMI as an independent predictor (adjusted OR 0.98; 95% CI 0.97-0.99, P=0.021). The area under the curve (AUC) was the highest for aspartate aminotransferase (AUC=0.886, 95% CI 0.69-0.98), fol-lowed by lactate dehydrogenase (AUC=0.879, 95% CI 0.68-0.98), platelet mass index (AUC=0.864, 95% CI 0.66-0.97), platelet count (AUC=0.860, 95% CI 0.65-0.97), ferritin (AUC=0.811, 95% CI 0.59-0.94), and alanine aminotransferase (AUC=0.796, 95% CI 0.58-0.93).

Conclusions: PMI showed promising predictive value for intensive care requirement in pediatric CCHF patients, maintaining significance in multivariate analysis. Several laboratory parameters including AST, LDH, and platelet count showed high diagnostic accuracy for identifying severe disease. These readily available parameters can guide early risk stratification and resource allocation in pediatric CCHF management.

Keywords

Biomarkers / Crimean-Congo hemorrhagic fever / Intensive care units / Pediatric / Prognosis

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