BIOCHEMICAL INDICATORS FOR THE EARLY DIAGNOSIS OF SEVERE DENGUE FEVER: AN INDIAN STUDY
Journal Title: INTERNATIONAL JOURNAL OF RESEARCH IN PATHOLOGY AND MICROBIOLOGY - Year 2018, Vol 2, Issue 4
Abstract
BACKGROUND Dengue also known as breakbone fever is a viral infection which is one of the most important mosquito borne diseases of the Indian subcontinent. It has become a major public health problem. Spread of the disease has lead to the recognition of atypical manifestations apart from the classical clinical features of dengue infection. Aim To determine the biochemical indicators for the early diagnosis of severe dengue fever. Methods A cross sectional study of dengue patients admitted as well as reporting to Medical OPD with confirmed infection with dengue virus was conducted in the year 2014 during the monsoon and post monsoon seasons. Patients with serological confirmation of dengue infection were classified according to the World Health Organization 2009 definitions of dengue fever without warning signs (DF) and dengue fever with warning signs or severe dengue (SD). All patients were evaluated prospectively for the first twelve days of the disease to determine their clinical and biochemical parameters. We evaluated the biochemical parameters as predictors of severe dengue fever (SD). Results Out of the 398 patients, 60 developed severe dengue fever (SD). Patients with severe dengue fever had higher levels of lactate dehydrogenase (LDH), creatine kinase (CK), blood glucose and aspartate aminotransferase, and lower levels of albumin, total cholesterol, triglycerides and calcium. Multivariate analysis showed that early alterations of CK (hazard ratio [HR] =6.98, 95% confidence interval [CI] = 2.34-20.85, P =0.001), LDH (hazard ratio [HR] =3.19, 95% confidence interval [CI] = 1.01-10.12, P <0.05), albumin (hazard ratio [HR] =2.54, 95% confidence interval [CI] = 1.09-5.92, P =0.03) and calcium (hazard ratio [HR] =1.49, 95% confidence interval [CI] = 0.62-3.56, P <0.37) were associated with severe dengue fever (SD). Triglyceride levels > 160mg/dl were negatively associated with developing severe dengue fever (SD) (hazard ratio [HR] =0.07, 95% confidence interval [CI] =0.01-0.59, P= 0.01). Conclusion The spectrum of dengue fever ranges from mild self limiting illness to severe life threatening infection. Dengue poses a huge burden on the public health care system. Biochemical alterations may be associated with severe forms of dengue infection and can be early prognostic markers for monitoring the illness and identifying patients who can benefit from the future therapies.
Authors and Affiliations
Kamlesh Kumar Singh, Khushi Ram Rathi, Satish Mendonca, Pooja Gupta, Devika Gupta
Keywords
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