Prognostic value of mean platelet volume and neutrophil to lymphocyte ratio in patients with Crimean-Congo Hemorrhagic Fever

Abstract

Objective: Crimean-Congo hemorrhagic fever (CCHF) virus, a Nairovirus within the family Bunyaviridae, causes severe disease in humans. Pancytopenia, organ failures and disseminated intravascular coagulation may occur as a result of CCHF infection. The aim of this study was to determine whether there is a change in the mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), and whether these might be predictors for the duration of hospitalization.

Methods: A total of 50 CCHF patients (27 M and 23 F) and a similar age group of 47 healthy individuals (27 M and 20 F) were included in the study. Hematologic and biochemical tests inclusive of C-reactive protein were conducted on patients and controls. To determine the independent predictors of the duration of hospitalization, a multivariate logistic regression analysis was performed.

Results: The MPV was higher in patients than that of the controls [8.4 (min/max 6.4-9.4) fL vs. 7.0 (min/max 6.0-8.7) fL, p<0.001]. The NLR and PLR were similar in both groups. The predictors of the length of hospitalization included decreased white blood (WBC) cell and platelet counts (p<0.001 and p=0.002, respectively), together with elevated pro­thrombin time (PT) (p=0.013) creatinine (p=0.033) and glucose levels (p=0.044).

Conclusion: The MPV was higher in patients but NLR and PLR were similar in both groups. The MPV, NLR and PLR did not serve as predictors of hospitalization length. However, elevation of PT, creatinine, glucose, along with decreased WBC and platelets counts were found to be predictors of hospitalization period. J Microbiol Infect Dis 2015;5(2): 51-56

Ayşe Ertürk, Erkan Cüre, Emine Parlak, Medine Cumhur Cüre, Süleyman Yüce, Zulal Özkurt

Prognostic value of mean platelet volume and neutrophil to lymphocyte ratio in patients with Crimean-Congo Hemorrhagic Fever Ayşe Ertürk, Erkan Cüre, Emine Parlak, Medine Cumhur Cüre, Süleyman Yüce, Zulal Özkurt  Recep Tayyip Erdogan University, School of Medicine, Department of Infectious Disease, Rize, Turkey. J Microbiol Infect Dis 2015; 5(2): 51-56 doi: 10.5799/ahinjs.02.2015.02.0176

Key words: Crimean-Congo hemorrhagic fever; mean platelet volume; neutrophil-to-lymphocyte ratio; platelet-tolymphocyte ratio; hospitalization period.

Keywords

• Crimean-Congo hemorrhagic fever; mean platelet volume; neutrophil-to-lymphocyte ratio; platelet-tolymphocyte ratio; hospitalization period

-

Öz

Amaç: Kırım-Kongo Kanamalı Ateşi (KKHA) virüsü, Bunyaviridae ailesine üye Nairovirus olup insanlarda ciddi hastalığa neden olur. KKKA enfeksiyonunda pansitopeni, organ yetersizliği ve yaygın damar-içi pıhtılaşma ortaya çıkabilir. Bu çalışmanın amacı, ortalama trombosit hacmi (MPV), nötrofil-lenfosit oranı (NLR) ve trombosit-lenfosit oranı (PLR)’nda bir değişiklik olup olmadığını ve bu parametrelerin hastanede kalış süresi için prediktör olup olamayacağını belirlemektir.Yöntem: Toplam 50 KKHA hastalığı bulunan (27 M ve 23 F) ve benzer yaş grubunda toplam 47 (27 M ve 20 F) sağlıklı birey çalışmaya alındı. Hematolojik ve biyokimyasal testleri ile C-reaktif protein (CRP), hasta ve kontrollerde çalışıldı. Hastanede kalış süresi üzerinde bağımsız prediktörleri belirlemek amacıyla çok değişkenli lojistik regresyon analizi yapıldı.Bulgular: MPV, hastalarda kontrollerden daha yüksek [8.4 (min / maks 6,4-9,4) fL vs 7.0 (min/maks 6,0-8,7) fL, p <0.001] idi. NLR ve PLR her iki grupta benzerdi. Hastanede kalış süresi prediktörleri: düşük beyaz kan hücreleri (WBC) ve trombosit sayısı (p <0.001 ve p=0.002 sırasıyla), bunlar yanı sıra uzamış protrombin zamanı (PT) (p=0.013), yüksek kreatinin (p=0.033) ve glukoz (p=0.044) düzeyleri olarak saptandı.Sonuç: MPV hasta grubunda daha yüksek olup NLR ve PLR oranları kontrol grubu ile benzerdi. MPV, NLR ve PLR hastanede kalış uzunluğu belirleyicisi olarak tespit edilmedi. Ancak, azalmış lökosit ve trombosit sayımı ile birlikte uzamış PT, artmış kreatinin ve glukoz düzeyleri, hospitalizasyon süresini predikte ettiği bulundu

Anahtar Kelimeler

• Kırım-Kongo Kanamalı Ateşi; ortalama trombosit hacmi; nötrofil/lenfosit oranı; trombosit/lenfosit oranı; hastanede yatış süresi

References

1. Oncü S. Crimean-Congo hemorrhagic fever: an overview. Virol Sin 2013;28:193-201.
2. Ftika L, Maltezou HC. Viral haemorrhagic fevers in healthcare settings. J Hosp Infect 2013;83:185-192.
3. Saksida A, Duh D, Wraber B, et al. Interacting roles of immune mechanisms and viral load in the pathogenesis of crimean-congo hemorrhagic fever. Clin Vaccine Immunol 2010;17:1086-1093.
4. Cure MC, Cure E, Kirbas A, et al. The effects of Gilbert’s syndrome on the mean platelet volume and other hematological parameters. Blood Coagul Fibrinolysis 2013;24:484-488.
5. Han JS, Park TS, Cho SY, et al. Increased mean platelet volume and mean platelet volume/platelet count ratio in Korean patients with deep vein thrombosis. Platelets 2013;24:590-593.
6. Ekiz F, Gürbüz Y, Basar Ö, et al. Mean platelet volume in the diagnosis and prognosis of Crimean-Congo hemorrhagic fever. Clin Appl Thromb Hemost 2013;19:441-444.
7. Okyay GU, Inal S, Oneç K, et al. Neutrophil to lymphocyte ratio in evaluation of inflammation in patients with chronic kidney disease. Ren Fail 2013;35:29-36.
8. Turkmen K, Erdur FM, Ozcicek F, et al. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int 2013;17:391-396.

9. Erduran E, Cakir M. Reactive hemophagocytic lymphohistiocytosis and Crimean-Congo hemorrhagic fever. Int J Infect Dis 2010;14:349-350.
10. Swanepoel R, Gill DE, Shepherd AJ, et al. The clinical pathology of Crimean-Congo hemorrhagic fever. Rev Infect Dis 1989;11:794-800.
11. Leblebicioglu H, Bodur H, Dokuzoguz B, et al. Case management
12. and supportive treatment for patients with Crimean-Congo hemorrhagic fever. Vector Borne Zoonotic Dis 2012;12:805-811.
13. Bıçakçı Z, Tavil B, Tezer H, Olcay L. Hemophagocytosis in a case with Crimean-Congo hemorrhagic fever and an overview of possible pathogenesis with current evidence. Turk J Pediatr 2013;55:344-348.
14. Cumhur Cure M, Cure E, Yuce S, et al. Mean Platelet Volume and Vitamin D Level. Ann Lab Med 2014;34:98-103.
15. Karadag-Oncel E, Erel O, Ozsurekci Y, et al. Plasma oxidative stress and total thiol levels in crimean-congo hemorrhagic Fever. Jpn J Infect Dis 2014;67:22-26.
16. Sui X, Tsuji K, Ebihara Y, et al. Soluble interleukin-6 (IL-6) receptor with IL-6 stimulates megakaryopoiesis from human CD34(+) cells through glycoprotein (gp)130 signaling. Blood 1999;93:2525-2532.
17. Pehlivan M, Okan V, Sever T, et al. Investigation of TNFalpha, TGF-beta 1, IL-10, IL-6, IFN-gamma, MBL, GPIA, and IL1A gene polymorphisms in patients with idiopathic thrombocytopenic purpura. Platelets 2011;22:588-595.
18. Troppan K, Deutsch A, Gerger A, et al. The derived neutrophil to lymphocyte ratio is an independent prognostic factor in patients with diffuse large B-cell lymphoma. Br J Cancer 2014;110:369-374.
19. Kaya H, Ertaş F, İslamoğlu Y, et al. Association between neutrophil
20. to lymphocyte ratio and severity of coronary artery disease. Clin Appl Thromb Hemost 2014;20:50-54.
21. Akinci E, Yilmaz M, Bodur H, et al. Analysis of lymphocyte subgroups in Crimean-Congo hemorrhagic fever. Int J Infect Dis 2009;13:560-563.
22. Tasdelen Fisgin N, Tanyel E, Doganci L, Tulek N. Risk factors for fatality in patients with Crimean-Congo haemorrhagic fever. Trop Doct 2009;39:158-160.
23. Eguchi K, Manabe I. Macrophages and islet inflammation in type 2 diabetes. Diabetes Obes Metab 2013;15:152-158.