Role of C- reactive proteins and liver function tests in assessing the severity of dengue fever

Abstract

Abstract
 Objective: To determine whether C-reactive protein and liver function tests can serve as severity markers for dengue fever.
 Methods: The cross-sectional study was conducted in 2015-16 in Karachi and comprised patients with dengue fever visiting a tertiary care hospital. World Health Organisation classifications 1997 and 2009 were used to categorise patients according to clinical signs and symptoms. Receiver Operating Characteristics curve was used to determine discriminative ability and optimum cut-off value of biochemical markers. Comparisons were done through one-way analysis of variance using SPSS 17.
 Results: Of the 218 patients, 133(61%) were males and 85(39%) were females. The overall mean age was 35.07+15.96 years. Levels of C-reactive protein and total bilirubin were significantly higher for dengue haemorrhagic fever compared to dengue fever; dengue shock syndrome compared to dengue fever; dengue shock syndrome compared to dengue haemorrhagic fever; and dengue shock syndrome compared to dengue fever / dengue haemorrhagic fever (p<0.05 each). Levels of alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase were significantly higher for dengue shock syndrome compared to dengue fever; dengue shock syndrome compared to dengue haemorrhagic fever; and dengue shock syndrome compared to dengue fever / dengue haemorrhagic fever (p<0.05 each). Levels of C-reactive protein, total bilirubin, alanine aminotransferase and alkaline phosphatise in patients with severe dengue were significantly higher compared to non-severe dengue.
 Conclusion: C-reactive protein and liver function tests were found to be effective biochemical markers in assessing dengue fever severity.

Assessment of Dengue Severity via Correlation of Aspartate Aminotransferase/ Platelet Ratio Index with Other Biochemical Markers in Patients with Dengue Admitted To a Teaching Hospital in Lahore

“…The current study did not indicate an increase in total bilirubin levels linked with severity of the disease which in in contrast to previous data from another study in Pakistan which showed a positive correlation between the two factors 1 .The current analysis did not reflect any significant correlation of serum alkaline phosphate levels with severity of dengue while a study from India has shown that raised serum Alp levels were statistically significant in severe cases in pediatric age group 20 .…”

“…Present data showed that dengue fever was frequently seen in the male population with 71.7% of the patients being male while 28.3 % were females which was in line with the results from a study in Karachi which showed 61% males and 39% females and another one from Saudi Arabia also showed 67% adult male patients 1,17 . Mean duration of hospital stay in current analysis was 4.09 ± 2.09 days while the study from Karachi sho-wed average duration to be 5.82±3.57 days 1 .…”

“…Another variable in current data was found to be ALT which had independent significant correlation with disease severity at; levels higher than 80.69. Increase in ALT was associated with increase in severity which was in keeping with study from Taiwan that also showed that raised ALT levels were associated with disease severity 10 while studies from Karachi and Indonesia did not show strong correlation of raised ALT levels with disease severity 1,12 .…”

“…Dengue cases have become higher in travelers from southeast Asian region have higher infectivity and rate of hospitalization 6,7 . Dengue is ende-mic in Pakistan; after two massive outbreaks in 1995 and 2005, outbreaks of dengue tend to afflict different cities on annual basis 1,8 . Dengue constitutes myalgia, arthralgia, retro-orbital pain, fever, headache and maculopapular rash commonly and rarely with myositis, arthritis, hepatitis and encephalitis as well 5,9 .…”

Diagnostic tests to mitigate the antimicrobial resistance pandemic—Still the problem child

“…A case in point is the appropriate use of antimicrobials for children presenting with undifferentiated fever in low-resource settings where bacterial, viral, and malarial infections predominate. C-reactive protein (CRP), the most commonly used diagnostic test to differentiate bacterial from viral infections, is non-specific and may be elevated in a number of non-bacterial infections including malaria and severe dengue fever [13,14], and with particular relevance to the current global pandemic, COVID-19 [15,16]. Eight years since the launch of the Longitude Prize, which aims to reward the first innovators to develop a point-of-care diagnostic test that will conserve antimicrobials and is accurate, rapid, affordable and easy to use anywhere in the world, we are still waiting for a winner [17].…”