Abstract
BackgroundWorldwide there is a need to develop simple effective predictors that can distinguish whether a patient will progress from dengue fever (DF) to life threatening dengue hemorrhagic (DHF) or dengue shock syndrome (DSS). We explored whether proteinuria could be used as such a marker.MethodsWe included patients admitted to hospital with suspected dengue fever. Starting at enrollment until discharge, each patient's daily spot urine protein creatinine ratio (UPCR) was measured. We classified those with confirmed dengue infection as DF or DHF (including DSS) based on WHO criteria. Peak and day of onset of proteinuria was compared between both groups.ResultsCompared to those with DF, patients with DHF had significantly higher median peak proteinuria levels (0.56 versus 0.08 g/day; p < 0.001). For patients with DHF, the median day of onset of proteinuria was at 6 days of defervescence, with a range of -2 to +3 days after defervescence. There were three patients with DF who did not have proteinuria during their illness; the five remaining patients with DF had a median day of onset of proteinuria of was at 6 days of defervescence with a range of 0 to +28 days.ConclusionsPeak UPCR could potentially predict DHF in patients with dengue requiring close monitoring and treatment.
Highlights
Worldwide there is a need to develop simple effective predictors that can distinguish whether a patient will progress from dengue fever (DF) to life threatening dengue hemorrhagic (DHF) or dengue shock syndrome (DSS)
The risk of severe disease and death underscores the importance of early detection of dengue fever (DF) and monitoring for signs of progression to severe disease
There are no simple clinical and laboratory markers that can predict whether a patient with DF will develop life threatening dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) [2]
Summary
Worldwide there is a need to develop simple effective predictors that can distinguish whether a patient will progress from dengue fever (DF) to life threatening dengue hemorrhagic (DHF) or dengue shock syndrome (DSS). There are no simple clinical and laboratory markers that can predict whether a patient with DF will develop life threatening dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) [2]. In 2004, Wills et al demonstrated among children with DSS markedly reduced plasma concentrations of differentsized proteins with a corresponding increase in fractional urinary clearances of the same proteins They suggested that a simple test of urine protein excretion may become a useful predictor for the subsequent development of DHF and DSS [4].
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