Serum Cortisol as a Biomarker of Severe Dengue

Abstract

Dengue infection presents a wide range of clinical symptoms. Serum cortisol is known as a severity predictor of serious infection but is not yet clearly understood in dengue infection. We aimed to investigate the pattern of cortisol response after dengue infection and evaluate the possibility of using serum cortisol as the biomarker to predict the severity of dengue infection. This prospective study was conducted in Thailand during 2018. Serum cortisol and other laboratory tests were collected at four time points: day 1 at hospital admission, day 3, day of defervescence (DFV) (4–7 days post-fever onset), and day of discharge (DC). The study recruited 265 patients (median age (IQR) 17 (13, 27.5)). Approximately 10% presented severe dengue infection. Serum cortisol levels were highest on the day of admission and day 3. The best cut-off value of serum cortisol level for predicting severe dengue was 18.2 mcg/dL with an AUC of 0.62 (95% CI, 0.51, 0.74). The sensitivity, specificity, PPV and NPV were 65.4, 62.3, 16 and 94%, respectively. When we combined serum cortisol with persistent vomiting and day of fever, the AUC increased to 0.76. In summary, serum cortisol at day of admission was likely to be associated with dengue severity. Further studies may focus on the possibility of using serum cortisol as one of the biomarkers for dengue severity.

Evaluating the importance of clinical manifestations and laboratory parameters associated with progression to severe dengue in children

“…Chaiyaratana et al 49 showed that a serum ferritin level ≥1200 ng/mL had a high sensitivity, but a relatively low specificity to predict the occurrence of severe dengue. Bongsebandhu et al 50 showed that D-dimer was significantly associated with dengue severity. Early increasing D-dimer in the febrile stage could predict the severity of dengue infection during the initial stage of the illness, with a 68.4% positive predictive value.…”

Common arboviruses and the kidney: a review

“…There is evidence of cortisol changes in dengue. Patients with severe dengue seem to have increased levels of cortisol, but the exact meaning of this remains unclear 64 .…”

“…There is an ongoing debate about the use of parenteral corticosteroids in severe dengue 65 . There is a WHO guideline for dengue management 64 . Patients should be cautioned against taking anti-inflammatory drugs because of the risk of bleeding in severe thrombocytopenia 50 , 67 , 68 .…”

“…Há evidências de alterações do cortisol na dengue. Os pacientes com dengue grave parecem ter níveis aumentados de cortisol, mas o significado exato disso ainda não está claro 64 .…”

“…Há um debate contínuo sobre o uso de corticosteroides parenterais na dengue grave 65 . Existe uma diretriz da OMS para o manejo da dengue 64 . Os pacientes devem ser advertidos contra o uso de drogas antiinflamatórias devido ao risco de hemorragia na trombocitopenia grave 50 , 67 , 68 .…”