Background Predictive markers represent a solution for the proactive management of severe dengue. Despite the low mortality rate resulting from severe cases, dengue requires constant examination and round-the-clock nursing care due to the unpredictable progression of complications, posing a burden on clinical triage and material resources. Accordingly, identifying markers that allow for predicting disease prognosis from the initial diagnosis is needed. Given the improved pathogenesis understanding, myriad candidates have been proposed to be associated with severe dengue progression. Thus, we aim to review the relationship between the available biomarkers and severe dengue. Methodology We performed a systematic review and meta-analysis to compare the differences in host data collected within 72 hours of fever onset amongst the different disease severity levels. We searched nine bibliographic databases without restrictive criteria of language and publication date. We assessed risk of bias and graded robustness of evidence using NHLBI quality assessments and GRADE, respectively. This study protocol is registered in PROSPERO (CRD42018104495). Principal findings Of 4000 records found, 40 studies for qualitative synthesis, 19 for meta-analysis. We identified 108 host and viral markers collected within 72 hours of fever onset from 6160 laboratory-confirmed dengue cases, including hematopoietic parameters, biochemical substances, clinical symptoms, immune mediators, viral particles, and host genes. Overall, inconsistent case classifications explained substantial heterogeneity, and meta-analyses lacked statistical power. Still, moderate-certainty evidence indicated significantly lower platelet counts (SMD -0.65, 95% CI -0.97 to -0.32) and higher AST levels (SMD 0.87, 95% CI 0.36 to 1.38) in severe cases when compared to non-severe dengue during this time window. Conclusion The findings suggest that alterations of platelet count and AST level—in the first 72 hours of fever onset—are independent markers predicting the development of severe dengue.

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e17576 Background: With the increase in survival of cancer patients, consequently, increasing their quality of life is mandatory as well. Sleep disturbances, particularly Obstructive Sleep Apnea (OSA), is one of the main complaints of cancer patients in which patients face frequent episodes of upper airway closure during sleep. Possible causes for OSA include either the specific cancer or its treatment whether sedatives, narcotics, radiotherapy, or chemotherapy, but the primary cause is still hard to prove. Our aim was to investigate the association between the occurrence of OSA and radiotherapy in cancer patients. Methods: On the 9th of September, 2018, we have searched comprehensively 12 electronic databases to retrieve relevant studies. All eligible studies that assess the association between OSA and radiotherapy in cancer patients were included in our meta-analysis. Quality assessment of included studies was done using the NIH tool for cohort and cross-sectional studies. Results: Fourteen studies met our selection criteria, eight studies were eligible for our meta-analysis. There was a positive association between the occurrence of OSA and radiotherapy in cancer patients (OR 1.16, 95% CI [0.52–2.56]; P = 0.718). OSA was noted in 103 of 181 cancer patients who received radiotherapy, yielding a remarkable overall prevalence of 63% (95% CI [0.36–0.85]; P = 0.343). A positive risk ratio for the development of OSA in cancer patients treated with radiotherapy was detected (RRs 1.27, 95% CI [0.81–2.00]; P = 0.297). The overall mean of apnea hypopnea index (AHI) for patients with OSA in six studies was 22.45. Conclusions: These findings point to a striking association between OSA risk and radiotherapy in cancer patients. Since the early recognition and management of OSA in such patients may play an important role in improving their quality of life, we recommend screening all cancer patients treated with radiation for early signs of OSA to further improve their survival.

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