Procalcitonin and clinical factors associated with severe dengue infection in hospitalised adults in Malaysia

Sani, Huzairi; Syazana, Nada; Azhar, Zahir Izuan; Isa, Mohamad Rodi; Yuhana, Muhamad Yazli

doi:10.1016/j.idh.2018.09.081

Cited by 3 publications

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“…As shown in patients during the initial phase of bacteremia, after an initial increase in CRP, levels drop over several days, whereas after the sudden drop of serum albumin levels due to trans-capillary leakage, serum levels remain low for a much longer period [ 16 ]. Patients who present with community-acquired bacterial or viral infections are more likely to require intensive care unit (ICU) treatment if serum albumin levels on admission to hospital are low [ 104 , 105 ]. Patients with colorectal cancer who develop infectious complications after laparoscopic surgery have more pronounced postoperative hypoalbuminemia on days 2 and 3 than patients with uncomplicated surgery [ 106 ], suggesting that measurement of serum albumin levels may be helpful in the early recognition of postoperative infection.…”

Section: Hypoalbuminemia and Prognosis In Infectionsmentioning

confidence: 99%

Hypoalbuminemia as Surrogate and Culprit of Infections

Wiedermann¹

2021

IJMS

145

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Hypoalbuminemia is associated with the acquisition and severity of infectious diseases, and intact innate and adaptive immune responses depend on albumin. Albumin oxidation and breakdown affect interactions with bioactive lipid mediators that play important roles in antimicrobial defense and repair. There is bio-mechanistic plausibility for a causal link between hypoalbuminemia and increased risks of primary and secondary infections. Serum albumin levels have prognostic value for complications in viral, bacterial and fungal infections, and for infectious complications of non-infective chronic conditions. Hypoalbuminemia predicts the development of healthcare-associated infections, particularly with Clostridium difficile. In coronavirus disease 2019, hypoalbuminemia correlates with viral load and degree of acute lung injury and organ dysfunction. Non-oncotic properties of albumin affect the pharmacokinetics and pharmacodynamics of antimicrobials. Low serum albumin is associated with inadequate antimicrobial treatment. Infusion of human albumin solution (HAS) supplements endogenous albumin in patients with cirrhosis of the liver and effectively supported antimicrobial therapy in randomized controlled trials (RCTs). Evidence of the beneficial effects of HAS on infections in hypoalbuminemic patients without cirrhosis is largely observational. Prospective RCTs are underway and, if hypotheses are confirmed, could lead to changes in clinical practice for the management of hypoalbuminemic patients with infections or at risk of infectious complications.

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Section: Hypoalbuminemia and Prognosis In Infectionsmentioning

confidence: 99%

Hypoalbuminemia as Surrogate and Culprit of Infections

Wiedermann¹

2021

IJMS

145

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“…To complicate matters further, features of dengue encephalitis on brain imaging are also nonspecific and variable, ranging from diffuse cerebral edema and intracranial hemorrhage/microhemorrhages to localized encephalitic changes [ 6 ]. Increasingly, procalcitonin has been proposed as a predictor of severe dengue [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Procalcitonin is a well-established predictor of severity in bacterial infections and increasingly in viral infections [ 13 , 14 ]. In dengue infections, the procalcitonin level is raised in patients with severe dengue and those with bacterial co-infections [ 7 , 8 , 15 ]. Cutoffs of 0.3–0.7 μg/L and 1.14 μg/L are used to predict severe dengue and bacterial co-infections, respectively [ 7 , 8 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…In dengue infections, the procalcitonin level is raised in patients with severe dengue and those with bacterial co-infections [ 7 , 8 , 15 ]. Cutoffs of 0.3–0.7 μg/L and 1.14 μg/L are used to predict severe dengue and bacterial co-infections, respectively [ 7 , 8 , 15 ]. Raised procalcitonin is also associated with death in patients with severe dengue ( P =0.021) [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Cutoffs of 0.3–0.7 μg/L and 1.14 μg/L are used to predict severe dengue and bacterial co-infections, respectively [ 7 , 8 , 15 ]. Raised procalcitonin is also associated with death in patients with severe dengue ( P =0.021) [ 8 ]. For our patient, the degree of procalcitonin elevation most likely signified severe dengue rather than a bacterial co-infection.…”

Section: Discussionmentioning

confidence: 99%

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A Rare Case of Dengue Encephalitis with Raised Procalcitonin

Nadarajan

Toh

2021

Am J Case Rep

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Patient: Male, 65-year-old Final Diagnosis: Dengue encephalitis Symptoms: AMS Medication:— Clinical Procedure: — Specialty: Infectious Diseases Objective: Rare co-existance of disease or pathology Background: Dengue virus is a common arbovirus with uncertain neurotropism. Dengue encephalitis is a rare but fatal manifestation of severe dengue. Diagnosis requires high clinical suspicion. It should be routinely considered in patients with encephalopathy, especially in countries where dengue virus is endemic. Unlike other forms of severe dengue, the typical warning signs and biochemical derangements are not reliable markers for dengue encephalitis. Alternative biochemical markers of dengue encephalitis are needed. Case Report: We present a case of dengue encephalitis with distinctly raised procalcitonin (13.2 μg/L), in the absence of the typical warning signs and biochemical derangements of severe dengue. The patient was a 65-year-old man with fever and sudden loss of consciousness in the absence of other localizing signs/symptoms. Inflammatory markers were raised, with findings of leptomeningeal enhancement on brain computed tomography suggestive of meningoencephalitis. Septic workup was unremarkable (normal renal and liver functions, negative blood and urine cultures). The typical neurotropic microorganisms were not detected in the cerebrospinal fluid. On day 4 of admission, the patient reported abdominal pain and hematuria with a new onset of bicytopenia. Subsequent investigations for dengue infection were positive for serum dengue NS1 antigen and dengue RNA (type 2 strain) in cerebrospinal fluid, confirming the diagnosis of dengue encephalitis. The patient was managed supportively and experienced full clinical recovery. Conclusions: Dengue encephalitis is a rare condition with nonspecific biochemical and imaging abnormalities. We demonstrated that a raised procalcitonin level can occur in the setting of dengue encephalitis. In endemic countries, this finding may prompt further investigations for dengue encephalitis in patients with meningoencephalitis.

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Comprehensive analysis of multivariable models for predicting severe dengue prognosis: systematic review and meta-analysis

Lee

Hyun

Park

2022

Transactions of the Royal Society of Tropical Medicine and Hygiene

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Dengue fever has often been confused with other febrile diseases, with deterioration occurring in the later state. Many predictive models for disease progression have been developed, but there is no definite statistical model for clinical use yet. We retrieved relevant articles through Global Health, EMBASE, MEDLINE and CINAHL Plus. The Prediction Model Risk of Bias Assessment Tool was adopted to assess potential bias and applicability. Statistical analysis was performed using Meta-DiSc software (version 1.4). Of 3184 research studies, 22 were included for the systematic review, of which 17 were selected for further meta-analysis. The pooled data of predictive accuracy was as follows: the sensitivity was 0.88 (95% CI 0.86 to 0.89), the specificity was 0.60 (95% CI 0.59 to 0.60), the positive likelihood ratio was 2.83 (95% CI 2.38 to 3.37), the negative likelihood ratio was 0.20 (95% CI 0.14 to 0.0.29) and the diagnostic OR was 16.31 (95% CI 10.25 to 25.94). The area under the summary receiver operating characteristic curve value was 0.86 (SE=0.02) with 0.79 (SE=0.02) of the Cochran Q test value. The overall predictive power of models in this study was relatively high. With careful adaption and standardization, the implementation of predictive models for severe dengue could be practical in actual clinical settings.

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Procalcitonin and clinical factors associated with severe dengue infection in hospitalised adults in Malaysia

Cited by 3 publications

References 0 publications

Hypoalbuminemia as Surrogate and Culprit of Infections

Hypoalbuminemia as Surrogate and Culprit of Infections

A Rare Case of Dengue Encephalitis with Raised Procalcitonin

Comprehensive analysis of multivariable models for predicting severe dengue prognosis: systematic review and meta-analysis

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