[A New Score for Predicting Mortality in Crimean-Congo Hemorrhagic Fever Associating CURB-65 with Bleeding: CURB-65+B]. / Kirim-Kongo Kanamali Atesinde Mortaliteyi Öngörmede CURB-65'i Kanama ile Birlestiren Yeni Bir Skor: CURB-65+B.

The clinical spectrum of Crimean-Congo hemorrhagic fever (CCHF) disease ranges from mild to fatal. Adult patients infected with the CCHF virus have a case fatality rate ranging from 3% to 30%. In order to measure the severity and mortality of CCHF disease, scoring systems comprised of laboratory data and clinical observations have been developed. In this study, it was aimed to develop a scoring system that was easy to use and reliable, with parameters that are often looked at in clinical practice to predict mortality in CCHF disease. For this purpose, a new scoring system that combines CURB-65 and bleeding (CURB-65+B) was developed. The mortality prediction performance of this score in CCHF disease was evaluated. This study was conducted as a retrospective, single-center study in patients diagnosed with CCHF in a tertiary care hospital in a region where CCHF is endemic between April 2016 and October 2022. Five hundred patients with verified polymerase chain reaction (PCR) and/or IgM positive for CCHF were included in the study. In the CURB-65+B score, variables believed to be related with mortality; such as confusion, elevated urea, tachypnea, hypotension, age 65 or older, and the presence of bleeding, were assessed. The CURB-65+B scores of the patients were calculated and evaluated at the time of admission to the hospital. The median age of the included patients was 48, and 302 (60.4% of the total) were male. Bleeding was observed in 136 (27.2%) and mortality was observed in 17 (3.4%) of the patients. At the time of hospital admission, a CURB-65+B score that was more than three points was found to be a significant factor in predicting mortality. Among the initially evaluated laboratory parameters, bleeding, CURB-65 and CURB-65+B scores, the indicator with the highest predictive power for mortality was the CURB-65+B score with a cut-off value of above 3 points. The sensitivity of the CURB-65+B score was 88.2%, and the specificity was 95.9%. The predictive power of the score for mortality was 0.972. It was observed that the CURB-65+B score has a high predictive power in CCHF disease mortality. If the CURB-65+B score was higher than three points, it was discovered that the Kaplan-Meier survival analysis would have resulted in a 25.57-times shorter survival time and considerably lower survival times. In addition it was observed that, there was no mortality observed in any of the patients who had a score of 0 on the CURB-65+B score. As a result, in our study, it was determined that the CURB65+B score could be a useful, reliable and practical tool to easily calculate the mortality of CCHF patients during hospital admission and to guide the referral processes related to patient triage.

[The Role of Blood Urea Nitrogen and C-Reactive Protein and Their Ratios to Albumin in Predicting Mortality in Crimean-Congo Hemorrhagic Fever]. / Kirim-Kongo Kanamali Atesinde Kan Üre Azotu ve C-Reaktif Proteinin, Albümine Oraninin Mortalite Tahminindeki Rolü.

Crimean-Congo hemorrhagic fever (CCHF) is an acute febrile hemorrhagic disease that can be fatal. Almost one-eighth of people infected with CCHF develop serious illness. The mortality rate is high due to severe bleeding, diffuse intravascular coagulation, shock, and multiple organ failure. Early detection of serious illness can play a key role in developing effective treatment and follow-up strategies. C-reactive protein (CRP), blood urea nitrogen (BUN), and albumin have previously been evaluated as markers of clinical severity in infectious diseases. This study aimed to evaluate the role of these readily available and inexpensive biomarkers and their ratios as predictors of mortality risk in patients with CCHF. This retrospective observational single-center study was conducted between May and October 2022 in a regional hospital in northeastern Türkiye, where the incidence of CCHF is the highest. Hundred and fifty patients aged 18 years and over with a definitive diagnosis of CCHF were included; patients with chronic kidney disease requiring long-term hemodialysis and those with missing data were excluded from the study. The patients' demographic characteristics, comorbidities, initial complaints, and epidemiological, clinical, and laboratory findings were recorded. Receiver operating characteristics (ROC) curve analysis was used to determine the predictive power of the studied biomarkers. Categorical and continuous variables found to be significant for mortality were evaluated using univariate logistic regression. Variables found to be significant in this test were used to create a multivariate logistic regression model to identify independent risk factors for mortality. The median age of the patients was 49 (18-89) years and 93 (62.0%) were men. Twelve patients (8.0%) required intensive care and 11 (7.3%) died. Complaints of abdominal pain (p= 0.010), hypotension (p= 0.002), somnolence (p< 0.001), and bleeding (p< 0.001) at the time of hospital admission were significantly more common among non-surviving patients. BUN and CRP were the biomarkers with the highest diagnostic power for mortality. A BUN cut-off value of 19.5 mg/dl had 100% sensitivity and 74.1% specificity, while a CRP cut-off value of 31.5 mg/L had 100% sensitivity and 81.8% specificity. CRP/albumin ratio (CAR) and BUN/albumin ratio (BAR) had higher predictive power than all individual biomarkers. At a cut-off point of 0.98, CAR had diagnostic power of 0.942 (95% confidence interval= 0.901-0.984), 100% sensitivity, and 84.9% specificity for mortality. At a cut-off of 0.50, BAR predicted mortality with diagnostic power of 0.932 (95% confidence interval= 0.879-0.984), 100% sensitivity, and 81.3% specificity. In univariate logistic regression analysis, the presence of bleeding, somnolence, and hypotension at the time of admission; higher troponin, total bilirubin, neutrophil count, activated partial thromboplastin time, prothrombin time, and age; and lower platelet count, fibrinogen, low-density lipoprotein cholesterol, and total cholesterol were significant risk factors determined for poor prognosis. Multivariate logistic analysis performed with these parameters revealed that somnolence, CAR, and BAR were independent risk factors for predicting mortality in CCHF. In conclusion, BAR and CAR, more easily and quickly obtained than severity scores, had higher sensitivity and specificity in predicting mortality than single biomarkers, and can be used during hospital admission for CCHF.

[A Case Report on Subarachnoid Hemorrhage Secondary to Neurobrucellosis in a Patient with Cerebral Aneurysm]. / Serebral Anevrizmali Hastada Nörobrusellozise Sekonder Subaraknoid Kanama: Olgu Sunumu.

Brucellosis is a multisystemic infection produced by a gram-negative bacillus that can develop a variety of clinical symptoms and complications. Involvement of the central nervous system is a challenging and dangerous consequence of systemic brucellosis. The neurobrucellosis clinical spectrum can be classified as central and peripheral. Meningitis, encephalitis, polyradiculoneuritis, cranial nerve involvement, depression, abscess and cerebrovascular events are some of the potential complications that may develop. The link between neurobrucellosis and cerebrovascular accident has been reported infrequently in the literature. In this report, a case of neurobrucellosis confirmed by cerebrospinal fluid agglutination test and who developed subarachnoid hemorrhage associated with cerebral aneurysm, which is a rare condition in its course was presented. Serum Rose Bengal test and serum Brucella standard tube agglutination (STA) tests were positive at a titer of 1/640 in a 38-year-old male patient who had complaints of fever, sweating, myalgia, arthralgia, weakness, head-neck-back pain and difficulty in walking for 14 days. On magnetic resonance imaging, Brucella sacroiliitis was identified. The patient's fever, head and neck pain continued and nuchal rigidity was found to be positive. Neurobrucellosis was diagnosed based on the cerebrospinal fluid (CSF) examination, which revealed a high white blood cell count, high protein, low glucose level, and STA in CSF at 1/640 titers. Imaging of the brain was conducted concurrently with cerebrospinal fluid analysis indicated subarachnoid hemorrhage caused by cerebral aneurysm rupture. In addition to the medical treatment, the aneurysm rupture was closed with surgical intervention. Three months of simultaneous triple antibiotic treatment were administered to the patient. In the third month of the treatment, the patient was completely cured and no longer had any problems. Although uncommon, subarachnoid hemorrhage due to aneurysm rupture is one of the cerebrovascular consequences of neurobrucellosis. In the process of differential diagnosis of cerebrovascular occurrences, particularly in areas where brucellosis is an endemic disease, it is important to keep in mind that neurobrucellosis can imitate a variety of diseases and cause cerebrovascular events.