Abstract
BackgroundCurrently, there are no biomarkers that can predict the incidence of dengue shock and/or organ failure, although the early identification of risk factors is important in determining appropriate management to reduce mortality. Therefore, we sought to determine the factors associated with dengue shock and/or organ failure and to evaluate the prognostic value of serum procalcitonin (PCT) and peripheral venous lactate (PVL) levels as biomarkers of dengue shock and/or organ failure.Methodology/Principal FindingsA prospective observational study was conducted among adults hospitalized for confirmed viral dengue infection at the Hospital for Tropical Diseases in Bangkok, Thailand between October 2013 and July 2015. Data, including baseline characteristics, clinical parameters, laboratory findings, serum PCT and PVL levels, management, and outcomes, were recorded on pre-defined case report forms. Of 160 patients with dengue, 128 (80.0%) patients had dengue without shock or organ failure, whereas 32 (20.0%) patients developed dengue with shock and/or organ failure. Using a stepwise multivariate logistic regression analysis, PCT ≥0.7 ng/mL (odds ratio [OR]: 4.80; 95% confidence interval [CI]: 1.60–14.45; p = 0.005) and PVL ≥2.5 mmol/L (OR: 27.99, 95% CI: 8.47–92.53; p <0.001) were independently associated with dengue shock and/or organ failure. A combination of PCT ≥0.7 ng/mL and PVL ≥2.5 mmol/L provided good prognostic value for predicting dengue shock and/or organ failure, with an area under the receiver operating characteristics curve of 0.83 (95% CI: 0.74–0.92), a sensitivity of 81.2% (95% CI: 63.6–92.8%), and a specificity of 84.4% (95% CI: 76.9–90.2%). Dengue shock patients with non-clearance of PCT and PVL expired during hospitalization.Conclusions/SignificancePCT ≥0.7 ng/mL and PVL ≥2.5 mmol/L were independently associated with dengue shock and/or organ failure. The combination of PCT and PVL levels could be used as prognostic biomarkers for the prediction of dengue shock and/or organ failure.
Highlights
Dengue is the most important arthropod-borne viral disease, and it exerts a high burden on populations and public health systems in most tropical countries [1,2]
Our study showed that a combination of serum procalcitonin levels 0.7 ng/mL and peripheral venous lactate levels 2.5 mmol/L at admission could discriminate between patients who did and did not develop shock and/or organ failure, with high sensitivity and specificity
A low positive predictive value (PPV) of 39.3% and an LR+ of 2.6, but a high negative predictive value (NPV) of 91.9% and an likelihood ratio (LR–)of 0.4, were obtained for warning signs (WSs) 4, which indicated a small decrease in the likelihood of developing dengue shock and/or organ failure when the number of WSs was
Summary
Dengue is the most important arthropod-borne viral disease, and it exerts a high burden on populations and public health systems in most tropical countries [1,2]. Clinical manifestations range from acute febrile illness to severe dengue, which is a life-threatening condition [1]. The World Health Organization (WHO) has implemented a goal of reducing dengue mortality by at least 20% and morbidity by 25% by the year 2020 [2]. Recognition of severe dengue would help clinicians achieve close monitoring and provide proper fluid resuscitation in order to prevent severe disease, which would reduce mortality and morbidity. The revised 2009 WHO case definition was introduced in order to improve early recognition of severe dengue by increasing awareness of warning signs [1]. There are no biomarkers that can predict the incidence of dengue shock and/or organ failure, the early identification of risk factors is important in determining appropriate management to reduce mortality. We sought to determine the factors associated with dengue shock and/or organ failure and to evaluate the prognostic value of serum procalcitonin (PCT) and peripheral venous lactate (PVL) levels as biomarkers of dengue shock and/or organ failure
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