Relationship between clinical course and apoptosis in patients with Crimean congo hemorrhagic fever

İntroduction and Purpose Crimean Congo Haemorrhagic Fever (CCHF) is a multisystemic disease that causes severe morbidity and mortality. Although the majority of cases recover after an acute febrile episode, the case fatality rate is reported to be approximately 30% worldwide, this rate is around 5-10% in Turkey. Studies on the causative agent in the disease process enable data to be collected on the course of the disease. The monitoring, experience and expertise gained in this way can be useful in controlling the disease and halting its progression. To elucidate the underlying mechanisms of ongoing CCHF cases around the world, clinical and pathologic evaluation of the data from our province in our study, how the course of the disease in the region will continue in our study, will shed light on the paths to be followed in the early stages of treatment. Method The study included 49 adult patients who were admitted to Yozgat Bozok University Research and Practice Hospital, Department of Infectious Diseases and Clinical Microbiology and diagnosed with CCHF. Patients were divided into 2 groups: mild and severe cases using the SGS score (Severity Rating Score). There were 25 patients in the mild patient group and 24 patients in the severe patient group. Ascending blood samples from venous blood sent to laboratories for routine examinations from patients diagnosed with CCHF were used. For the definitive diagnosis of patients hospitalized with a preliminary diagnosis of CCHF, blood samples are analyzed for the causative agent by molecular methods (real time PCR) in the reference laboratory of the Public Health Institution of Turkey, Ministry of Health. Blood samples of patients diagnosed with definite CCHF by this method were analyzed for apoptosis markers (Clusterin, TRAIL, caspase-8, cytochrome-C, Apaf-1) by ELISA (Enzyme-Linked ImmunoSorbent Assay) method at Yozgat Bozok University Medical Faculty Medical Microbiology Laboratory. The results were statistically interpreted according to age, gender and clinical picture. Statistical analyses were performed with STATA 11.0 (College station, Texas, USA) computer program. Statistical significance level was accepted as p<0.05. Findings Acute period TRAIL levels were higher in patients with mild course compared to the convalescent period (p<0.001). No change was found between clusterin, Apaf-1, caspase-8, cytochrome-c levels of patients with mild course in the acute and convalescent periods. In patients with severe course, TRAIL levels were significantly higher in the acute period compared to the convalescent period (p=0.005). No change was found between clusterin, Apaf- 1, caspase-8, cytochrome-c levels of patients with severe course in acute and convalescent periods. In the acute phase of the disease, clusterin, TRAIL, caspase-8 and Apaf-1 levels were significantly higher in severe patients compared to mild patients, while no significant difference was observed between cytochrome-C levels (p=0.459). In the convalescent period, TRAIL levels of severe patients were significantly higher than those of mild patients (p=0.009); no significant difference was found in clusterin, caspase-8, Apaf-1 and cytochrome-C levels between the two patient groups. The sensitivity, specificity, positive predictive value, positive predictive value and negative predictive value of Clusterin in the detection of severe patients were 91.67%, 64%, 89.79% and 51.73%, respectively. The sensitivity, specificity, positive predictive value, positive predictive value and negative predictive value of TRAIL protein were found to be 87.5%, 68%, 90.43% and 61.16%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of caspase-8 protein were 91.67%, 84%, 97.62% and 58.44%, respectively. The sensitivity, specificity, positive predictive value, positive predictive value and negative predictive value of Apaf-1 protein were found to be 83.33%, 60%, 83.89% and 59.01%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and positive predictive value of cytochrome-C protein were 58.33%, 52%, 58.86% and 50.42%, respectively. Results Apoptosis was found to be induced in the acute period, especially in severe patients. Apoptosis and proteins affecting apoptosis play an important role in the pathogenesis of the disease. High levels of apoptosis proteins detected in the acute phase predict an exacerbation of the disease. Apoptosis proteins have a significant percentage of sensitivity and specificity in detecting severely ill patients. Predicting the severity of the disease at an early stage will reduce permanent organ damage and mortality with appropriate treatment approaches. Keywords:Crimean-Congo Haemorrhagic Fever,severity grading score,apoptozis.