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Prognostic value of sCD163, IL-6, PLR, and SII in predicting disease severity in Crimean-Congo hemorrhagic fever: a
Ferhan Kerget1, Buğra Kerget2,3, Nurten Nur Aydın1
1Depertmant of Infection Diseases and Clinical Microbiology, Aksaray University School of Medicine, Aksaray, Turkey.
Insights
New biomarkers, soluble CD163 (sCD163) and interleukin-6 (IL-6), accurately predict severe Crimean-Congo hemorrhagic fever (CCHF). These markers, linked to inflammation, can improve early risk assessment for this dangerous tick-borne illness.
Area of Science:
- Infectious Diseases
- Immunology
- Biomarkers
Background:
- Crimean-Congo hemorrhagic fever (CCHF) is a severe tick-borne viral infection characterized by high mortality.
- Macrophage activation and systemic inflammation are key drivers of CCHF pathogenesis.
- Early identification of prognostic biomarkers is critical for risk stratification and timely intervention.
Purpose of the Study:
- To evaluate soluble CD163 (sCD163) and interleukin-6 (IL-6) as prognostic biomarkers for CCHF severity.
- To compare the predictive accuracy of sCD163 and IL-6 against established inflammatory indices like PLR and SII.
- To investigate the correlation between macrophage activation markers and systemic inflammation in CCHF patients.
Main Methods:
- Prospective study enrolling 60 CCHF patients (30 severe, 30 mild-moderate) and 50 healthy controls.
- Measurement of sCD163 and IL-6 via ELISA.
- Calculation of platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) from blood counts.
Main Results:
- Severe CCHF cases exhibited significantly higher levels of sCD163 and IL-6 compared to mild-moderate cases and controls (p < 0.05).
- sCD163 showed strong positive correlations with IL-6 and inflammatory markers (AST, ALT) and a negative correlation with platelet count.
- ROC analysis identified sCD163 (AUC=0.853) and IL-6 (AUC=0.852) as highly accurate predictors of severe CCHF, outperforming PLR and SII.
Conclusions:
- sCD163 and IL-6 are robust early prognostic biomarkers for severe CCHF.
- These biomarkers reflect the interplay between macrophage activation and systemic inflammation in CCHF.
- Their accurate predictive value can enhance clinical assessment and guide prompt therapeutic strategies for CCHF patients.
Abstract:
Crimean - Congo hemorrhagic fever (CCHF) is a severe tick-borne infection with high mortality, where macrophage activation and systemic inflammation drive pathogenesis. Prognostic biomarkers are crucial for early risk stratification. In this prospective study (April - July 2025), 60 confirmed CCHF patients (30 severe, 30 mild - moderate) and 50 healthy controls were enrolled. Soluble CD163 (sCD163) and interleukin-6 (IL-6) were measured by ELISA, while platelet-to-lymphocyte ratio (PLR) and systemic immune - inflammation index (SII) were derived from blood counts. Severe cases showed lower platelet counts, PLR, and SII, but higher AST, ALT, LDH, GGT, CK, direct bilirubin, fibrinogen, sCD163, and IL-6 than mild - moderate patients (all p < 0.05). Compared with controls, CCHF patients had elevated sCD163 and IL-6 (p < 0.001). sCD163 correlated negatively with platelet count (r=-0.453, p = 0.001) and positively with AST, ALT, and IL-6 (r = 0.953, p < 0.001), linking macrophage activation to systemic inflammation. ROC analysis showed sCD163 (AUC = 0.853) and IL-6 (AUC = 0.852) as accurate predictors of severe CCHF, with an sCD163 cutoff of 2.7 ng/mL yielding 96% sensitivity and 77% specificity. PLR and SII also distinguished severity but with lower accuracy. These findings highlight sCD163 and IL-6 as strong early prognostic biomarkers that may improve clinical assessment and guide timely therapeutic interventions in CCHF.
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