# Prognostic Significance of CRP/Albumin, D-Dimer/Albumin, D-Dimer/Fibrinogen Ratios and Triglyceride-Glucose Index in Crimean–Congo Hemorrhagic Fever: A Prospective Observational Study

## TL;DR

This study shows that specific inflammatory markers can predict mortality in patients with Crimean–Congo hemorrhagic fever.

## Contribution

The study introduces new inflammatory markers (CAR, DAR, DFR, TGI) as potential tools for predicting mortality in CCHF patients.

## Key findings

- CAR, DAR, DFR, and TGI levels were significantly higher in CCHF patients compared to healthy controls.
- DFR and TGI showed the highest predictive power for mortality in CCHF patients.
- Higher levels of these markers were associated with shorter survival times in CCHF patients.

## Abstract

Background: Crimean–Congo hemorrhagic fever (CCHF) is a severe zoonotic viral infection with high mortality rates. This study aimed to examine the prognostic value of new-generation inflammatory markers—CRP/albumin ratio (CAR), D-dimer/albumin ratio (DAR), D-dimer/fibrinogen ratio (DFR), and triglyceride-glucose index (TGI)—in predicting mortality among patients diagnosed with CCHF. Methods: This prospective study involved 76 patients with a positive polymerase chain reaction test for CCHF and 38 age- and sex-matched healthy controls between 15 April 2023 and 15 October 2024. Participants’ demographic, clinical, and laboratory data at presentation were recorded. Results: CAR, DAR, DFR, and TGI levels were significantly higher in the patient group compared to the control group (all p < 0.001). Furthermore, when mortal cases were compared with survivors, all of these markers were found to be significantly higher in the mortal group (p = 0.005, p = 0.004, p = 0.001, and p = 0.003, respectively). In Kaplan–Meier analysis, survival time was significantly shorter in patients with higher levels of these parameters (p < 0.001 for all). In the Receiver Operating Characteristic analysis conducted to differentiate mortal cases from survivors, DFR and TGI were identified as the markers with the highest predictive power (area under the curve: 0.938 and 0.899, respectively). Conclusions: Inflammatory markers CAR, DAR, DFR and TGI may serve as significant prognostic tools to predict mortality in CCHF.