Predictors of Mortality in Crimean-Congo Hemorrhagic Fever Patients Admitted at a Tertiary Care Hospital in Pakistan over the Last 10 Years: A Case-Control Study

The objective was to identify predictors of mortality in hospitalized patients with Crimean-Congo hemorrhagic fever (CCHF). A case-control study was conducted on patients hospitalized with CCHF from 2012 to 2022. Risk factors for mortality in CCHF patients were analyzed using logistic regression. A total of 86 patients with a median age of 36 years (interquartile range [IQR], 27–36 years) were included, and the majority were males (78, 90.7%). Thirty-one patients (36%) were cases, whereas 55 (64%) were control patients. Based on univariate logistic regression analysis, patients who were in an age group of $40 years (odds ratio [OR]: 4.85; 95% CI: 1.8–12.4) or with presence of gum bleeding (OR: 2.66; 95% CI: 1.0–6.8), unit increase in white blood cell count (WBC) (OR: 1.09; 95% CI: 1.00–1.07), serum glutamate-pyruvate transaminase of $500 U/L (OR: 3.68; 95% CI: 1.4–9.3), serum glutamic-oxaloacetic transaminase (SGOT) of $1,000 U/L (OR: 8.72; 95% CI: 2.6–28.3), prothrombin time (PT) of $120 seconds (OR: 9.85; 95% CI: 3.2–29.8), international normalized ratio of $5 (OR: 15.8; 95% CI: 2.0–125.3), or acute respiratory distress syndrome (ARDS) (OR: 28.27; 95% CI: 5.84–136.9) were found to be significantly associated with mortality in CCHF. Factors found to be independently associated with mortality on multivariate analysis included ARDS (adjusted OR [aOR]: 27.7; 95% CI: 4.0–190.5), unit increase in WBC (aOR: 1.02; 95% CI: 1.02–1.26), SGOT of $1,000 U/L (aOR: 23.6; 95% CI: 2.32–241.7), and PT of $120 seconds (OR: 10.2; 95% CI: 2.00–52.4). CCHF is a rare but fatal disease, and patients with ARDS and increased WBC, high SGOT level, and increased PT indicative of liver injury and coagulopathy at the time of hospitalization are at high risk for mortality.