Early diagnostic markers in predicting the severity of dengue disease

Abstract

The aim of the present study was to determine whether the serum ferritin, the biomarker of an acute phase reactant and the gall bladder wall edema, an early indicator of capillary leakage can predict the severity of dengue fever. This study included 131 patients, who were between the age group of 18–80 years. The patients presented to our department with an acute illness, within the first four days of high temperature. The statistical analysis of this study was performed by using the Chi-square and independent Student’s t tests. The diagnostic markers are considered statistically significant, if the serum ferritin level is higher than 500 ng/ml and the gall bladder wall thickness is more than 3 mm. The present study observed that, 39 patients (89%) who had severe dengue (n = 44) revealed a significant gall bladder wall thickening, and this correlation was significant statistically (p < 0.000). It was also observed that, the ferritin levels have a highly significant positive correlation with the severity of dengue. The severe dengue patients had a mean ferritin level of 9125.34 μg/l, whereas the non-severe group had 4271 μg/l. This comparison was also statistically significant, as the p value was 0.003. We report that the serum ferritin levels have a highly significant positive correlation with the severity of dengue. The gall bladder wall edema during the third and fourth day of the illness was also associated with severe dengue. However, diffuse gall bladder wall thickening and high serum ferritin levels are also reported in various other conditions and their exact cause have to be determined by the correlation of associated clinical findings and imaging features.

Serum ferritin level as a prognostic biomarker for predicting dengue disease severity: A systematic review and meta‐analysis

“…Loss of follow‐up and loss of the sample did not apply to the selected studies; therefore, study attrition was judged as low RoB for all papers (except one) by both raters. Overall, four studies were judged for a high RoB due to incomplete descriptions of key characteristics of study participants, study attrition, and study confounding measurement, 21,24,29,38 three had a moderate RoB, 19,32,52 and 11 studies were judged to have a low RoB (Figure 2). Both raters agreed on 84.26% of all the domains (90 out of 108).…”

“…Participants 21,24,29,38 three had a moderate RoB, 19,32,52 and 11 studies were judged to have a low RoB (Figure 2). Both raters agreed on 84.26% of all the domains (90 out of 108).…”

“…However, estimation of such prognostic markers should require less technical expertise, be cost‐effective, and be able to provide an accurate prediction at an early time point of infection so that appropriate measures can be taken to prevent disease progression. Multiple studies have reported the association of serum ferritin levels with the severity of dengue disease 11,19–42 . Assays for the estimation of serum ferritin are easy to perform and comparatively less expensive, and serum ferritin levels may be considered as a prognostic marker to predict severe dengue.…”

Endothelial and inflammatory pathophysiology in dengue shock: New insights from a prospective cohort study in Vietnam

“…The results of this analysis indicate that while patients with both dengue shock and septic shock have evidence of pro-inflammatory hypercytokinaemia, there is a phenotypic difference between the inflammatory response in dengue shock (ferritin predominant) and septic shock (IL-6 predominant). Hyperferritinaemia has been reported as both a diagnostic and prognostic biomarker for dengue by several groups [12][13][14][15], but only one study has reported ferritin values quite as high as in our cohort; Kan et al found that mortality was twice as high in adults with severe dengue plus features of secondary haemophagocytic lymphohistiocytosis, compared to severe dengue alone [16]. Advancing this finding, we found that ferritin at enrolment was associated with mortality in a large group of adults with dengue shock, and that it was associated with other relevant clinical markers of disease severity such as SOFA score and requirement for ICU admission.…”

Comparación clínica y laboratorial de la fiebre amarilla severa versus dengue grave en Perú

“…Sangrado profuso que se considera clínicamente importante; 3. Compromiso grave de órganos (OMS, 2018;Moras et al, 2022). Definición de fiebre amarilla severa: Presencia de oliguria, algún signo de sangrado, bradicardia, insuficiencia hepática y renal, disfunción cerebral, convulsiones o coma (OMS, 2018;Oyono et al, 2022).…”