Potential biomarkers for the clinical prognosis of severe dengue

Abstract

Currently, several assays can confirm acute dengue infection at the point-of-care. However, none of these assays can predict the severity of the disease symptoms. A prognosis test that predicts the likelihood of a dengue patient to develop a severe form of the disease could permit more efficient patient triage and treatment. We hypothesise that mRNA expression of apoptosis and innate immune response-related genes will be differentially regulated during the early stages of dengue and might predict the clinical outcome. Aiming to identify biomarkers for dengue prognosis, we extracted mRNA from the peripheral blood mononuclear cells of mild and severe dengue patients during the febrile stage of the disease to measure the expression levels of selected genes by quantitative polymerase chain reaction. The selected candidate biomarkers were previously identified by our group as differentially expressed in microarray studies. We verified that the mRNA coding for CFD, MAGED1, PSMB9, PRDX4 and FCGR3B were differentially expressed between patients who developed clinical symptoms associated with the mild type of dengue and patients who showed clinical symptoms associated with severe dengue. We suggest that this gene expression panel could putatively serve as biomarkers for the clinical prognosis of dengue haemorrhagic fever.

Inverse correlation between serum albumin and serum lactate in adults with dengue

“…(5,6) If this tissue hypoxia is not recognized earlier, to be managed by appropriate and aggressive fluid therapy, it will increase the number of complications and the mortality rate of these patients. (7,8) Currently serum lactate is used as a biomarker to evaluate tissue hypoxia in patients with sepsis. (16) The serum lactate level of a patient is a biomarker for the severity of systemic hypoperfusion, and does not depend on organ failure and shock.…”

“…dengue shock syndrome, will follow, thus increasing the mortality rate of patients with dengue hemorrhagic fever. (7,8) Plasma leakage resulting in tissue hypoxia is determined from the hematocrit (ht) and plasma protein concentration (especially albumin), and from the presence of pleural effusion and/or ascites upon imaging, using both plain X-rays of the thorax and ultrasonography of the abdomen. (9)(10)(11)(12) The study of Santosa et al (11) on children with hemorrhagic fever showed an increase in the hematocrit of 20% or higher, which value is currently considered to indicate the occurrence of significant plasma leakage, and was found to correspond to a serum lactate level of >2.4 mmol/ L (sensitivity 79.31%, specificity 77.42%).…”

Características clínicas de pacientes hospitalizados durante un brote epidémico de dengue

“…Esto demuestra la facilidad de obtener un hemograma en los servicio de salud de nuestro país. El desarrollo de cualquier signo de alarma en pacientes con diagnóstico de dengue indica la necesidad de hospitalización y observación estrecha, con el uso de líquidos por vía parenteral en pacientes 50,51,52 con una ingesta oral inadecuada o un hematocrito en ascenso . En otros estudios el dolor abdominal 36 persistente fue la causa más frecuente de hospitalización .…”

“…Por lo tanto, todos los actores sanitarios debemos promover la disminución de la circulación viral con medidas medioambientales. La vacuna [49][50][51][52][53][54] contra el dengue aún no está disponible .…”

Discovery and Characterization of Potential Prognostic Biomarkers for Dengue Hemorrhagic Fever

“…3 Previously identified markers of dengue severity include cytokines (i.e., tumor necrosis factor alpha [TNFα] and Interleukin 6 [IL-6]), vascular permeability proteins, clotting cascade regulators, and gene expression profiles. [4][5][6][7][8][9][10][11][12][13][14][15][16][17] These severity markers are not, however, currently being used to guide patient management. 18,19 It is unclear why these severity markers are not being used, possibly because detection methods are expensive, slow, or require sophisticated equipment.…”