Evaluation of the associations between endothelial dysfunction, inflammation and coagulation in Crimean-Congo hemorrhagic fever patients
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Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne zoonotic viral disease. The aim of this study was to evaluate the association between inflammation, coagulation and endothelial dysfunction in CCHF. The study population consisted of 40 patients and 50 healthy controls. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), endocan, high sensitive C-reactive protein (hsCRP), international normalized ratio (INR), prothrombin time (PT), activated partial thromboplastin time (aPTT) and platelets values were determined in blood samples. Median hsCRP (p < 0.0001), ALT (p < 0.001), AST (p < 0.001) and aPTT (p < 0.001) values were found to be higher in CCHF patients than in the healthy control subjects. In contrast, median endocan (p = 0.0006) and platelet (p < 0.001) concentrations were found to be lower in CCHF patients than in healthy controls. Serum hsCRP concentrations positively correlated with PT, aPTT and INR in CCHF patients, whereas serum endocan levels were not correlated with hsCRP, PT, aPTT and INR. In conclusion, endothelial dysfunction is one of the key steps in CCHF disease development and serum endocan may be used as a biomarker to evaluate endothelial dysfunction in patients. There is no relationship between increased inflammation and endothelial dysfunction. Coagulation abnormalities might be related to the impaired hepatic synthetic function of coagulation factors. Increased hsCRP concentrations may have a compensatory role in restoring impaired hemostasis in CCHF. Further research is needed to confirm these findings and to examine possible explanations.
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interests to declare.
In this study, the protocol was approved by the institutional ethics committee of Cumhuriyet University, as mentioned in the paper. Written informed consent was obtained from all participants. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
No financial support was received for this study.
- 16.Bechard D, Gentina T, Delehedde M, Scherpereel A et al (2001) Endocan is a novel chondroitin sulfate/dermatan sulfate proteoglycan that promotes hepatocyte growth factor/scatter factor mitogenic activity. J Biol Chem 276:48341–48349. https://doi.org/10.1074/jbc.M108395200 CrossRefPubMedGoogle Scholar
- 17.Ridker PM (2005) C-reactive protein, inflammation, and cardiovascular disease: clinical update. Curr Issues Cardiol 32:384–386Google Scholar
- 19.Yudkin JS, Stehouwer CDA, Emeis JJ, Coppack SW (1999) C-Reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue? Arterioscler Thromb Vasc Biol 19:972–978. https://doi.org/10.1161/01.ATV.19.4.972 CrossRefPubMedGoogle Scholar
- 20.Schalkwijk CG, Poland DCW, Van Dijk W et al (1999) Plasma concentration of C-reactive protein is increased in type I diabetic patients without clinical macroangiopathy and correlates with markers of endothelial dysfunction: evidence for chronic inflammation. Diabetologia 42:351–357. https://doi.org/10.1007/s001250051162 CrossRefPubMedGoogle Scholar
- 21.Devaraj S, Xu D, Jialal I (2003) C-Reactive protein increases plasminogen activator inhibitor-1 expression and activity in human aortic endothelial cells: implications for the metabolic syndrome and atherothrombosis. Circulation 107:398–404. https://doi.org/10.1161/01.CIR.0000052617.91920.FD CrossRefPubMedGoogle Scholar
- 24.Cermak J, Key NS, Bach RR et al (1993) C-Reactive protein induces human peripheral blood monocytes to synthesize tissue factor. Blood 82:513–520. papers3://publication/uuid/1B1B9252-69D3-4DCE-BC48-75A6483C38A6Google Scholar
- 25.Gris J-C, Faillie J-L, Cochery-Nouvellon É et al (2011) ISTH overt disseminated intravascular coagulation score in patients with septic shock: automated immunoturbidimetric soluble fibrin assay vs d-dimer assay. J Thromb Haemost 9:1252–1255. https://doi.org/10.1111/j.1538-7836.2011.04270.x CrossRefPubMedGoogle Scholar
- 27.Bakır M, Gözel MG, Köksal I et al (2014) Validation of a severity grading score (SGS) system for predicting the course of disease and mortality in patients with Crimean-Congo hemorrhagic fever (CCHF). Eur J Clin Microbiol Infect Dis 34:325–330. https://doi.org/10.1007/s10096-014-2238-0 CrossRefPubMedGoogle Scholar
- 29.Kim JH, Park MY, Kim CN et al (2012) Expression of endothelial cell-specific molecule-1 regulated by hypoxia inducible factor-1α in human colon carcinoma: impact of ESM-1 on prognosis and its correlation with clinicopathological features. Oncol Rep 28:1701–1708. https://doi.org/10.3892/or.2012.2012 CrossRefPubMedGoogle Scholar
- 50.Singh U (2005) C-Reactive protein decreases tissue plasminogen activator activity in human aortic endothelial cells: evidence that C-reactive protein is a procoagulant. Arterioscler Thromb Vasc Biol 25:2216–2221. https://doi.org/10.1161/01.ATV.0000183718.62409.ea CrossRefPubMedGoogle Scholar