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Dynamic Prognostic Value of IL-6/PLT Ratio for Mortality Discrimination in Patients With Crimean-Congo Hemorrhagic
Murtaza Öz1, Caner Öksüz1, Ertuğrul Keskin1
1Department of Infectious Diseases and Clinical Microbiology, Sivas Cumhuriyet University, Sivas, Türkiye.
Insights
The interleukin-6-to-platelet (IL-6/PLT) ratio is a strong predictor of mortality in Crimean-Congo Hemorrhagic Fever (CCHF). This biomarker effectively monitors patient risk throughout infection.
Area of Science:
- Infectious Diseases
- Clinical Pathology
- Biomarker Research
Background:
- Crimean-Congo Hemorrhagic Fever (CCHF) is a severe viral illness with significant mortality.
- Accurate prognostic markers are crucial for timely clinical intervention and patient management.
- Existing individual laboratory parameters have limitations in predicting CCHF mortality.
Purpose of the Study:
- To compare the prognostic performance of individual laboratory markers and derived biomarker ratios for mortality in CCHF patients.
- To evaluate the temporal stability of the most effective prognostic index.
- To identify a reliable biomarker for early and dynamic monitoring of mortality risk in CCHF.
Main Methods:
- Retrospective analysis of 1171 adult patients with laboratory-confirmed CCHF.
- Comparison of mortality discriminative performances of individual biomarkers (e.g., IL-6) and derived ratios (e.g., IL-6/PLT, IL-6/Ca, Ferritin/PLT, Ferritin/Ca) using ROC analysis.
- Assessment of the prognostic stability of the top-performing index through sequential ROC analyses.
Main Results:
- Interleukin-6 (IL-6) showed the highest discriminative ability among individual parameters (AUC: 0.887).
- The IL-6/PLT ratio demonstrated superior performance (AUC: 0.920) compared to individual markers and other ratios.
- The IL-6/PLT ratio maintained high prognostic stability throughout the infection course.
Conclusions:
- The IL-6/PLT ratio is a powerful candidate biomarker for predicting mortality in CCHF.
- This ratio, reflecting inflammation and hemostatic dysfunction, enables early and dynamic risk monitoring.
- The IL-6/PLT ratio offers improved prognostic accuracy over individual laboratory parameters.
Abstract:
This study aimed to compare the prognostic performances of individual laboratory parameters and biomarker ratios derived from them formortality in patients with Crimean-Congo Hemorrhagic Fever (CCHF), and to examine the temporal stability of the strongest index. A total of 1171 adult patients with laboratory-confirmed CCHF followed between 2014 and 2024 were retrospectively included in the study. Admission data were recorded, and the mortality discriminative performances of individual and derived biomarkers (interleukin-6-to-platelet ratio [IL-6/PLT], interleukin-6-to-calcium ratio [IL-6/Ca], ferritin-to-platelet ratio [Ferritin/PLT], and ferritin-to-calcium ratio [Ferritin/Ca]) for mortality were compared using ROC analysis. Ninety-seven patients (8.3%) resulted in mortality. Among the individual parameters, IL-6 demonstrated the highest discriminative ability for mortality (AUC: 0.887). Among the derived indices, the IL-6/PLT ratio demonstrated the highest overall performance with an AUC value of 0.920 (95% CI: 0.871-0.969; p < 0.001). The optimal cut-off value for the IL-6/PLT ratio was determined as 0.78 (88% sensitivity, 81% specificity). Mortality reached 100% in all patients with a ratio of ≥ 16. Sequential ROC analyzes demonstrated that the IL-6/PLT ratio maintained high prognostic stability throughout the course of infection. The IL-6/PLT ratio, a combined indicator of inflammatory response and hemostatic dysfunction, is a powerful biomarker candidate for the early and dynamic monitoring of mortality risk in CCHF.