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Purpose <p>Early risk stratification is critical in Crimean-Congo hemorrhagic fever. We compared the prognostic accuracy of the Severity Grading Score and the Severity Scoring Index for predicting severe outcomes and mortality in laboratory-confirmed Crimean-Congo hemorrhagic fever virus.</p> Methods <p>We conducted a systematic review and meta-analysis of prognostic accuracy studies according to PRISMA 2020 guidelines. MEDLINE, Embase, Scopus and Web of Science were searched from inception to November 7, 2025. Observational studies evaluating Severity Grading Score and/or Severity Scoring Index and reporting extractable prognostic accuracy data were included. Pooled sensitivity, specificity, likelihood ratios and diagnostic odds ratios (DOR) were estimated using bivariate random-effects models at prespecified cutoffs for mortality prediction (Severity Grading Score ≥ 9; Severity Scoring Index ≥10). Risk of bias was assessed using QUADAS-2.</p> Results <p>Fourteen studies met inclusion criteria. Ten studies evaluating Severity Grading Score (n = 1521) and four evaluating Severity Scoring Index (n = 478) were included in quantitative synthesis for mortality. Severity Grading Score showed very high specificity (0.99, 95% CI 0.95–1.00) but limited sensitivity (0.47, 95% CI 0.27–0.69), yielding a pooled DOR of 94.8. Severity Scoring Index demonstrated higher sensitivity (0.78, 95% CI 0.63–0.88) with high specificity (0.97, 95% CI 0.91–0.99) and a pooled DOR of 100.7. Using an observed mortality prevalence of ~9%, Severity Grading Score provided strong rule-in capacity, whereas Severity Scoring Index offered superior rule-out performance.</p> Conclusions <p>Both scores are clinically useful prognostic tools in Crimean-Congo hemorrhagic fever, but with distinct roles. Severity Grading Score is better suited for confirming high-risk status, while Severity Scoring Index performs better as an early triage tool to identify patients at risk of death. Prospective head-to-head validation with standardized outcomes is warranted to guide their incorporation into clinical triage protocols and management guidelines.</p>

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Prognostic accuracy of severity grading score and severity scoring index for predicting severe outcomes in Crimean-Congo hemorrhagic fever: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月12日

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  • Beatriz Rodríguez-Alonso,
  • Montserrat Alonso-Sardón,
  • Amparo López-Bernus,
  • Ángela Romero-Alegría,
  • Josué Pendones Ulerio,
  • Juan Luis Muñoz Bellido,
  • Antonio Muro,
  • Hugo Almeida,
  • Moncef Belhassen-García

摘要

Purpose

Early risk stratification is critical in Crimean-Congo hemorrhagic fever. We compared the prognostic accuracy of the Severity Grading Score and the Severity Scoring Index for predicting severe outcomes and mortality in laboratory-confirmed Crimean-Congo hemorrhagic fever virus.

Methods

We conducted a systematic review and meta-analysis of prognostic accuracy studies according to PRISMA 2020 guidelines. MEDLINE, Embase, Scopus and Web of Science were searched from inception to November 7, 2025. Observational studies evaluating Severity Grading Score and/or Severity Scoring Index and reporting extractable prognostic accuracy data were included. Pooled sensitivity, specificity, likelihood ratios and diagnostic odds ratios (DOR) were estimated using bivariate random-effects models at prespecified cutoffs for mortality prediction (Severity Grading Score ≥ 9; Severity Scoring Index ≥10). Risk of bias was assessed using QUADAS-2.

Results

Fourteen studies met inclusion criteria. Ten studies evaluating Severity Grading Score (n = 1521) and four evaluating Severity Scoring Index (n = 478) were included in quantitative synthesis for mortality. Severity Grading Score showed very high specificity (0.99, 95% CI 0.95–1.00) but limited sensitivity (0.47, 95% CI 0.27–0.69), yielding a pooled DOR of 94.8. Severity Scoring Index demonstrated higher sensitivity (0.78, 95% CI 0.63–0.88) with high specificity (0.97, 95% CI 0.91–0.99) and a pooled DOR of 100.7. Using an observed mortality prevalence of ~9%, Severity Grading Score provided strong rule-in capacity, whereas Severity Scoring Index offered superior rule-out performance.

Conclusions

Both scores are clinically useful prognostic tools in Crimean-Congo hemorrhagic fever, but with distinct roles. Severity Grading Score is better suited for confirming high-risk status, while Severity Scoring Index performs better as an early triage tool to identify patients at risk of death. Prospective head-to-head validation with standardized outcomes is warranted to guide their incorporation into clinical triage protocols and management guidelines.