Combination of inflammatory and vascular markers in the febrile phase of dengue is associated with more severe outcomes.
Vuong NL., Lam PK., Ming DKY., Duyen HTL., Nguyen NM., Tam DTH., Duong Thi Hue K., Chau NV., Chanpheaktra N., Lum LCS., Pleités E., Simmons CP., Rosenberger KD., Jaenisch T., Bell D., Acestor N., Halleux C., Olliaro PL., Wills BA., Geskus RB., Yacoub S.
BackgroundEarly identification of severe dengue patients is important regarding patient management and resource allocation. We investigated the association of 10 biomarkers (VCAM-1, SDC-1, Ang-2, IL-8, IP-10, IL-1RA, sCD163, sTREM-1, ferritin, CRP) with the development of severe/moderate dengue (S/MD).MethodsWe performed a nested case-control study from a multi-country study. A total of 281 S/MD and 556 uncomplicated dengue cases were included.ResultsOn days 1-3 from symptom onset, higher levels of any biomarker increased the risk of developing S/MD. When assessing together, SDC-1 and IL-1RA were stable, while IP-10 changed the association from positive to negative; others showed weaker associations. The best combinations associated with S/MD comprised IL-1RA, Ang-2, IL-8, ferritin, IP-10, and SDC-1 for children, and SDC-1, IL-8, ferritin, sTREM-1, IL-1RA, IP-10, and sCD163 for adults.ConclusionsOur findings assist the development of biomarker panels for clinical use and could improve triage and risk prediction in dengue patients.FundingThis study was supported by the EU's Seventh Framework Programme (FP7-281803 IDAMS), the WHO, and the Bill and Melinda Gates Foundation.