Temporal Changes in Sonographic Findings as Predictors of Disease Severity in Crimean–Congo Hemorrhagic Fever

Introduction: Crimean–Congo hemorrhagic fever (CCHF) is a life-threatening viral infection with multiorgan involvement. While laboratory markers are well-established, the prognostic value of ultrasonography (US) remains underexplored. This prospective study aimed to characterize abdominal US findings in patients with suspected CCHF and to assess their correlation with clinical parameters and disease severity. Materials and Methods: A total of 122 patients hospitalized with suspected CCHF were included and classified as RT-PCR positive ( n = 70) and RT-PCR negative control ( n = 52) groups. Serial abdominal US was performed on days 1, 3, and 5 of hospitalization. Sonographic findings, clinical data, and Severity Scoring Index (SSI) values were recorded and analyzed. Results: The most frequent sonographic findings in RT-PCR-positive patients were hepatomegaly (30%), gallbladder wall thickening (26%), periportal echogenicity (19%) and intra-abdominal free fluid (19%). Notably, gallbladder wall thickening was significantly more common in the patient group compared with controls ( p = 0.034), while splenomegaly was significantly more frequent in the RT-PCR-negative group ( p = 0.003). US findings showed significant regression by day 5, paralleling SSI improvement ( p < 0.001). Conclusion: Abdominal US serves as a complementary, non-invasive modality in the clinical evaluation and follow-up of patients with suspected CCHF. The correlation between US findings and SSI scores, together with the temporal evolution of sonographic changes, highlights its potential to be incorporated into future disease severity scoring systems as a non-invasive prognostic indicator. Routine use of abdominal US, particularly in endemic regions, may provide meaningful support in the early detection of complications, dynamic assessment of disease severity, and objective monitoring of treatment response, thereby enhancing clinical decision-making.