Related Experiment Video
Updated: Aug 30, 2025
Detection of Residual Donor Erythroid Progenitor Cells after Hematopoietic Stem Cell Transplantation for Patients with Hemoglobinopathies
Published on: September 6, 2017
Prognostic Value of Hemogram-Derived Ratios in Patients with Crimean-Congo Hemorrhagic Fever
Sumeyye Kazancioglu1, Aliye Bastug2, Burcu Ozdemir1
1Department of Infectious Diseases and Clinical Microbiology, Ministry of Health Ankara City Hospital, Ankara, Turkey.
Insights
Neutrophil-to-lymphocyte ratio (NLR), derived NLR (d-NLR), and AST-to-lymphocyte ratio index (ALRI) can predict Crimean-Congo hemorrhagic fever (CCHF) mortality. Survivors showed improved hemogram parameters, unlike non-survivors, indicating closer monitoring for the latter.
Area of Science:
- Infectious Diseases
- Hematology
- Epidemiology
Background:
- Crimean-Congo hemorrhagic fever (CCHF) is an emerging infectious disease with epidemic potential and significant mortality.
- Predicting CCHF patient outcomes is crucial for effective management and reducing mortality.
Purpose of the Study:
- To investigate hemogram parameters and derived ratios for predicting mortality in CCHF patients.
- To identify reliable biomarkers for CCHF mortality prediction.
Main Methods:
- Analysis of hemogram parameters and derived ratios in 207 CCHF patients (177 survivors, 30 non-survivors).
- Comparison of parameters on admission and the third day of hospitalization between survivor and non-survivor groups.
- Receiver operating characteristic (ROC) analysis to evaluate the predictive performance of biomarkers.
Main Results:
- Non-survivors exhibited higher neutrophils, NLR, d-NLR, AST, and ALRI compared to survivors.
- Lower platelet-to-lymphocyte ratio on admission and lower lymphocytes/monocytes on day three were observed in non-survivors.
- AST (day 3) and ALRI (day 3) showed the highest AUC (0.939 and 0.934) in ROC analysis. NLR and d-NLR also demonstrated significant predictive value.
Conclusions:
- Neutrophil-to-lymphocyte ratio (NLR), derived NLR (d-NLR), and AST-to-lymphocyte ratio index (ALRI) are valuable biomarkers for predicting CCHF mortality.
- Dynamic improvement in hemogram parameters and ratios is associated with survival.
- Patients not showing improvement in these parameters require closer monitoring.
Abstract:
Crimean-Congo hemorrhagic fever (CCHF) is an emerging infectious disease that has epidemic and pandemic potential and causes mortality. Predicting the outcome of the disease is important to guide the management of patients and prevent mortality. This study aimed to investigate hemogram parameters and hemogram-derived ratios for predicting mortality in 207 patients with CCHF (survivors = 177, nonsurvivors = 30). Compared with the survivor group, the nonsurvivor group had higher neutrophils, neutrophil-to-lymphocyte ratio (NLR), derived NLR (d-NLR), and aspartate aminotransferase (AST), AST-to-lymphocyte ratio index (ALRI) on admission and third day of hospitalization. Higher white blood cells (WBCs), lower platelet-to-lymphocyte ratio on admission, and lower lymphocytes, and monocytes on the third day were found in the nonsurvivor group. Evaluating the change of admission and the third day of laboratory values, a downward trend in neutrophils, NLR, d-NLR, ALRI, and an upward trend in WBCs were found statistically significant in the survivor group. These dynamic changes were not found in the nonsurvivor group. AST (third day) and ALRI (third day) had the highest area under the curve (AUC) in the receiver operating characteristic analysis (0.939 and 0.934, respectively; p-value is <0.0001 for all). The NLR on the third day than on admission had a higher AUC, the optimal cutoff value was 1.44, which resulted in a sensitivity of 93.33 and a specificity of 40.34 (AUC: 0.790, p < 0.0001). The d-NLR on the third day had a higher AUC (with a sensitivity of 81.48 and a specificity of 67.43) than on admission (0.781 and 0.669, respectively). CCHF is a common vector-borne disease and mortality rates are high. This study revealed that NLR, d-NLR, and ALRI can be used as biomarkers to predict mortality. Patients who survived had better improvement in hemogram parameters and ratios. Therefore, patients who do not show this improvement should be followed more closely.
