Comparative study of serum ferritin levels and hepatic transaminases between uncomplicated paediatric dengue inpatients and other febrile illnesses in Kanchipuram, India

Abstract

Background: Fever is the most common complaint with bringing children for hospital consultation. Dengue is a cause of public health concern with case fatality rate of 1%. Ferritin is an acute-phase reactant which is produced in response to infection and inflammation. Liver enzymes are also considered as markers of febrile illness. Aim of this study was to assess serum ferritin levels, aspartate-aminotransferase (AST) and alanine-aminotransferase (ALT) levels in pediatric inpatients with febrile illness, to correlate it with patient’s Dengue profile and to analyse these parameters with sub-group analysis of dengue and OFI.Methods: Among 120 children admitted for fever of more than 3 days duration were included in the study. 58 were Dengue-NS1 positive and the remaining 62 were considered to be OFI. Serum ferritin levels, AST and ALT were the investigative parameters measured at the time of admission for the study and treated as per WHO Dengue Guidelines. Data was coded and entered in Microsoft Excel 2013. Data was analysed using SPSS v16. p value of <0.05 was considered statistically significant.Results: Ferritin levels were higher in Dengue-IgM positive subgroup than in OFI subgroup (U= 173, Z score -6.09, p<0.00001). AST levels are higher in Dengue-NS1 positive subgroup than in OFI subgroup (U= 103, Z score -8.08, p<0.00001). AST levels were also higher in Dengue-IgM positive subgroup than in OFI subgroup (U= 377.5, Z score -4.86, p<0.00001). ALT levels are higher in Dengue-NS1 positive subgroup than in OFI subgroup (U=76, Z score -8.95, p<0.00001) as well as in Dengue-IgM positive subgroup than in OFI subgroup (U= 417, Z score -4.4, p<0.00001).Conclusions: Hyperferritinemia and elevation of hepatic-transaminases is seen in dengue. Although elevated in other febrile illnesses, it is elevated more so in dengue. This can be a predictor of severity of dengue fever, but needs to be confirmed in larger studies.

Hiperferitinemia pada Demam Brerdarah Dengue

“…Kadar SGOT dan SGPT juga lebih tinggi pada kelompok NS-1 positif dan kelompok IgM dengue positif dibandingkan kelompok penyakit demam lain. 11 Evalda dkk 12 melakukan studi yang membandingkan rata-rata kadar feritin pasien anak dengan syok dengue dan bukan syok dengue. Studi ini dilakukan di RSUD Dr. Moewardi, Surakarta dan RSUD Dr. Soetrasno, Rembang, dengan melibatkan 50 pasien anak sejak Desember 2016 hingga Mei 2017.…”

“…Namun tidak disebutkan secara pasti saat hari sakit ke berapa kadar feritin serum pasien dalam studi ini diperiksakan dan tidak disebutkan nilai cut-off dari kadar feritin serum. 11 Studi Evalda dkk 12 dilakukan di Indonesia yaitu di kota Surakarta dan Rembang selama enam bulan dengan populasi 50 pasien anak. Dari 50 pasien tersebut, 12 anak mengalami syok dengue (DSS).…”

“…Keadaan hiperferitinemia pada pasien sesuai dengan literaturliteratur yang ada dimana pemeriksaan feritin pada hari demam ke-4 dan ke-5 pada pasien dengue berat atau syok menunjukkan hiperferitinemia. 7,8,9,11,12 Pada pasien kami, kadar feritin didapatkan 14.594 ng/mL dan nilai tersebut sudah melebihi dari nilai cut-off feritin dalam literatur-literatur yang mendukung. 7,8,10,12 Selain hiperferitinemia, pada pasien kami juga ditemukan hemokonsentrasi dan trombositopenia pada saat yang bersamaan.…”