Increased levels of pentraxins protein and cytokines bear good association in patients with severe dengue infection

Goutam Patra,Sumi Mukhopadhyay,Bibhuti Saha

doi:10.1038/s41598-020-80144-0

Abstract

Dengue is an arboviral infection with high rates of morbidity and mortality throughout the tropics and sub-tropics. This work studied the status of pentraxin (CRP/SAP) protein, ferritin, TNF-α and IL-1β levels in Dengue patients of different pathophysiological manifestations. Accordingly, clinically confirmed Dengue cases (n = 97) were enrolled and subsequently blood parameters were studied by Haematology cell counter and Biochemistry Autoanalyser. CRP, SAP, ferritin, TNF-α and IL-1β ELISA were done in all the samples by using standard ELISA kits. Statistical Analysis was done in all the experiments. The levels of CRP (p < 0.0001), SAP (p < 0.0001), ferritin (p < 0.0001), TNF-α (p < 0.0001) and IL-1β (p < 0.0001) were high in patients with Severe Dengue as compared to Dengue without warning signs. High levels of SGOT, SGPT and decreased platelet counts were found in severe patients as compared to Healthy donor. CRP/SAP as well as TNF-α/IL-1β were independently associated with both dengue severity and overall disease manifestation. Statistically significant increased CRP, SAP, ferritin, TNF-α and IL-1β titres were correlated in patients with severe clinical manifestations as compared to mild disease forms of dengue. Elevated levels of pentraxin, TNF-α/IL-1β in blood during dengue infection could act as an early predictor in Severe Dengue infection.

Highlights

Dengue is an arboviral infection with high rates of morbidity and mortality throughout the tropics and sub-tropics
The first described acute phase protein (APP) was C-reactive protein (CRP), a positive Acute-phase proteins (APP) identified in h umans[28]
The median CRP level was significantly elevated in people with severe dengue compared with the less severe form (DwoWS/dengue with warning signal (DWWS))

Summary

Result

CRP levels in OFI were very low (median 5.22 pg/ml, IQR 2.35–14.28 pg/ml) as compared to SD (p < 0.0001) and DWWS (p < 0.001) (Fig. 2) Another acute phase protein, SAP was significantly increased in severe dengue infection (median of 38.43 ng/ml, IQR 30.97–46.48 ng/ml) versus HD (median value 3.51 ng/ml, IQR 2.85–4.1 ng/ml). SAP levels in OFI were low as compared to SD (p < 0.001) (Fig. 3) Further another acute phase protein ferritin levels increased in SD (1628 ng/ml, IQR 1430–1852 ng/ml) as compared to DWWS (1160 ng/ml, IQR 530–1307 ng/ ml). The platelet was found to negatively correlate with SAP levels (r = − 0.0284 with p = 0.008) These data indicate a possible influence of these acute phase proteins on elevation of SGOT and painful liver enlargement. These association indicate that IL-1β and TNF-α probably induces liver tissue injury, vascular damage and thrombocytopenia (Fig. 7)

Discussion

Findings

Materials and methods