Predictors for Severity of Dengue Infection during Early Days of Infection

Abstract

Hepatorenal dysfunction has been implicated in dengue virus infection due to the obvious effects of dengue virus infection on the hepatorenal organs. This study was undertaken to establish the possible role of different serum biomarkers involved to have roles in the liver and kidney to see the pathology and prognosis of dengue virus infection. It is an observational, descriptive and retrospective study conducted on 74 sero positive cases during the early days of dengue virus infection (1 - 7 days) confirmed by Real time PCR (CDC Atlanta) who, in the period of August to November 2011 visited a tertiary care hospital in Lahore. Patients of both genders and all age groups were included. Patients were divided into 3 age groups i.e. 11 - 30, 31 - 50, 51 - 70 years. The tests analysed were platelet count, serum alkaline phosphatase (ALP), alanine aminotransferase (ALT), urea, creatinine and albumin, protein concentrations. This article assesses the value of these serum biomarkers and its association with age, gender, platelet count and bleeding tendencies in dengue patients. Most of these parameters were normal in dengue infected patients except for albumin, urea and creatinine. Hypoalbuminemia was observed in (54.05 %) of patients, low creatinine (95.94 %) and raised urea (41.89 %) values were observed in patients with dengue virus infection. No association was observed between these serum biomarkers and bleeding. More dengue patients had declined platelet counts (< 50,000/µl). Dengue infection was more in males and in age group 11 - 30 years but hemorrhagic signs were more in females and in older patients of more than 50 years. From the study, impaired hepatorenal function, found to be common in dengue infected patients, was associated with declining levels of serum albumin, creatinine and raised levels of urea. Hence serum albumin, creatinine and urea can be used as predictive markers for the severity of dengue virus infection during early infection while it cannot help in differentiating dengue fever from dengue hemorrhagic fever. Our study is among the few to report involvement of the kidney along with liver during dengue infection.

Keywords

• Predictors of dengue infection
• dengue
• serum biomarkers
• liver function tests
• renal function tests