Ribavirin in Treatment of Crimean-Congo Hemorrhagic Fever (CCHF): An International Multicenter Retrospective Analysis

Abstract

Background. CCHF is a fatal viral hemorrhagic illness transmitted by ticks with no proven antiviral treatment. While ribavirin has been proposed as a potential therapy, results of previous studies are not conclusive. This multi-centric study is aimed to evaluate the efficacy of Ribavirin in treatment of CCHF. Methods. In a multi-center, non-interventional, retrospective observational study, 543 Turkish and Iranian hospitalized CCHF patients were evaluated (2011-2015). Patients' demographic, epidemiological, clinical characteristics, laboratory data, treatment and outcome variables were compared between patients who received ribavirin and supportive therapy and those who only received supportive therapy. Data analysis was performed by SPSS 16.0. Results. Data for 543 patients from 7 centers were reviewed (Table 1). Ribavirin was administered to 198 patients (36.5%) who were mainly younger than 65 years old (85%) and male (%65.2). Leukocyte count on admission was significantly higher in ribavirin group (p = 0.023). PT and aPTT on admission were significantly higher in the ribavirin group (p = 0.047 and 0.006, respectively), while bleeding was not significantly different (0.246). Platelets, Hemoglobin, liver enzymes, INR, CPK, LDH and DDimer levels on admission were not significantly different between groups. Ribavirin group had a significantly longer duration of hospitalization (7.4 +/- 3.3 versus 7.3 +/- 5.6, p = 0.042). Overall, 44 patients died of CCHF (8%). Mortality was observed in 15 patients who received ribavirin (7.6%) and in 29 (8.4%) patients in the non-ribavirin group. (p = 0.733). Nine patients died within the first 3 days (3 received ribavirin). Time from hospitalization to death was 6.4 +/- 5.9 days in the ribavirin versus 5.3 +/- 2.7 days in non-ribavirin group (p = 0.867). During hospitalization, platelet counts were significantly lower in the ribavirin group (p < 0.05), while leukocyte and hemoglobin counts were not significantly different (Table 2). Ribavirin group significantly needed more plasma transfusions (43.4% versus 29.3%) (p = 0.001). Need for platelet and erythrocyte transfusions were similar among two groups while in thrombocytopenic patients, ribavirin patients needed more frequent platelet transfu-sions (p = 0.013). Conclusion. Our findings suggest that ribavirin use did not significantly improve outcome in CCHF patient. (Figure Presented) .