Biochemical and radiological markers as predictors of dengue severity in children admitted in a tertiary care hospital

Kulothungan Ravishankar, Ponnurangam N. Vinoth, Padmasani Venkatramanan


Background: Dengue fever is the arboviral infection with the largest incidence worldwide. Clinical expression of dengue virus infection varies from no symptoms to severe dengue with shock. Severe Dengue is characterized by thrombocytopenia, spontaneous haemorrhages, and gradual plasma leakage that can lead to shock. Biochemical and radiological markers have not been evaluated prospectively in early stages of dengue and their utility as predictors of dengue children progressing to severe dengue have not been studied previously in our part of the country. The objective of this study was to evaluate biochemical and radiological markers as predictors of dengue severity.
Methods: This Prospective Cohort study was done in a Tertiary care teaching hospital (Sri Ramachandra Medical College) from January 2010 to June 2011. Children from the age of one month to ≤18 years, who fulfilled the WHO criteria for dengue fever, duration of clinical symptoms < 96 hrs and children with dengue NS 1 antigen positivity with or without IgM antibodies were included in the study. An informed consent was obtained and blood samples were taken for biochemical markers (AST, ALT, CPK and LDH) and radiological markers in the form of plasma leakage was detected by Chest X ray and Ultrasonogram of abdomen.
Results: 103 children with dengue infection were enrolled in the study, of which 50 children had warning signs at the time of admission. Among the 50 children with warning signs, 37 children progressed to severe dengue. Serum AST, ALT, CPK and LDH showed significant elevation in children with dengue with warning signs in comparison to children with dengue fever. Radiological markers Chest X-ray and Ultrasonogram abdomen also predicted plasma leakage significantly in children with warning signs than in children with dengue fever.
Conclusions: This study suggests that elevated AST, ALT, CPK, LDH, and signs of plasma leak detected within 96 hrs of onset of symptoms can predict a more severe form of dengue infection. Hence, these biochemical and radiological markers may be useful in identification and close monitoring of potentially sick children with dengue infection and serve as valuable prognostic markers early in the course of the illness.


Keywords: Dengue fever, Biochemical, Radiological, Markers

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World Health Organization. Dengue: Diagnosis, Treatment, Prevention and Control, New edn. Geneva: World Health Organization, 2009.

Duane J. Gubler. Dengue and Dengue Hemorrhagic Fever. Clin Microbiol Rev. 1998;7:480-96.

Rigau-Pérez JG, Clark GG, Gubler DJ, Reiter P, Sanders EJ, Vorndam AV, Dengue and dengue haemorrhagic fever. Lancet. 1998;352:971-7.

Kalayanarooj S, Vaughn DW, Nimmannitya S. Early clinical and laboratory indicators of acute dengue illness. J Infect Dis. 1997;176:313-21.

Luis Angel Villar-Centeno, Fredi Alexander Díaz-Quijano, and Ruth Aralí Martínez-Vega. Biochemical Alterations as Markers of Dengue Hemorrhagic Fever; Am. J. Trop. Med. Hyg. 2008;78:370-4.

VenkataSai V, Dev B, Krishnan R. Role of ultrasound in dengue fever. Br J Radiol. 2005;78:416-8.

Monath TP. Early indicators in acute dengue infection. Lancet. 1997;350:1719-20.

Wang LY, Chang WY, Lu SN, Chen TP. Sequential changes of serum transaminases and abdominal sonography in patients with suspected dengue fever. Kao Hsiung I Hsueh Tsa Chih. 1990;6:483-9.

Nguyen TL, Nguyen TH, Tieu NT. The impact of dengue hemorrhagic fever on liver function. Res Virol 1997;148:273-7.

Alvarez ME, Ramirez-Ronda CH. Dengue and hepatic failure.Am J Med. 1985;79:670-4.

Ray G, Kumar V, Kapoor AK, Dutta AK, Batra S.Status of antioxidants and other biochemical abnormalities in children with dengue fever. J Trop Pediatr. 1999;45:4-7.

Setiawan MW, Samsi TK, Wulur H, Sugianto D, Pool TN.Epigastric pain and sonographic assessment of the pancreas in dengue hemorrhagic fever. J Clin Ultrasound. 1998;26:257-9.

Jusuf H, Sudjana P, Djumhana A, Abdurachman SA. DHF with complication of acute pancreatitis related hyperglycemia: a case report. Southeast Asian J Trop Med Public Health. 1998;29:367-9.

Krippner R, Hanish G, Kretschmer H. Dengue fever with hemorrhagic manifestations after a stay in Thailand. Dtsch Med Wochenschr. 1990;115:858-62.

Souza LJ, Alves JG, Nogueira RM, Gicovate Neto C, Bastos DA, Siqueira EW, Souto Filho JT, Cezário Tde A, Soares CE, Carneiro Rda C. Aminotranferase changes and acute hepatitis in patients with dengue fever: analysis of 1,585case. Braz J Infect Dis. 2004;8(2):156-63

Chacko B and Subramaniam G.Clinical laboratory and radiological parameters in children with dengue fever. J Trop Pediatr. 2008;54(2):137-40.

Balasubramanian S, Janakiraman L, Kumar SS, Muralinath S, Shivbalan S. A reappraisal of the criteria to diagnose plasma leakage in dengue hemorrhagic fever. Indian Pediatr. 2006;43(4):334-9