Abstract
Background
Dengue is an important viral infection with different presentations. Predicting disease severity is important in triaging patients requiring hospital care. We aim to study the value of proteinuria in predicting the development of dengue hemorrhagic fever (DHF), utility of urine dipstick test as a rapid prognostic tool.
Methodology and principal findings
Adult patients with undifferentiated fever (n = 293) were prospectively enrolled at the Infectious Disease Research Clinic at Tan Tock Seng Hospital, Singapore from January to August 2012. Dengue infection was confirmed in 168 (57%) by dengue RT-PCR or NS1 antigen detection. Dengue cases had median fever duration of 6 days at enrolment. DHF was diagnosed in 34 cases according to the WHO 1997 guideline. Dengue fever (DF) patients were predominantly younger and were mostly seen in the outpatient setting with higher platelet level. Compared to DF, DHF cases had significantly higher peak urine protein creatinine ratio (UPCR) during clinical course (26 vs. 40 mg/mmol; p<0.001). We obtained a UPCR cut-off value of 29 mg/mmol based on maximum AUC in ROC curves of peak UPCR for DF versus DHF, corresponding to 76% sensitivity and 60% specificity. Multivariate analysis with other readily available clinical and laboratory variables increased the AUC to 0.91 with 92% sensitivity and 80% specificity. Neither urine dipstick at initial presentation nor peak urine dipstick value during the entire illness was able to discriminate between DF and DHF.
Conclusions
Proteinuria measured by a laboratory-based UPCR test may be sensitive and specific in prognosticating adult dengue patients.
Dengue infection is getting more common in recent years, affecting all age groups. Currently, there is no specific treatment for dengue. Close clinical monitoring and careful fluid therapy is the only way of management for those with severe dengue disease, i.e., dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). It is crucial to know among patients with dengue, who will potentially progress to DHF/DSS in the most reliable, economical and fastest way, so as to prioritise limited resources. We investigated the presence of protein in urine as an indicator of progression to DHF/DSS. Adult patients with dengue were enrolled to our clinic. Clinical data, blood and urine were collected. We found that patients who were going to develop DHF/DSS had increased protein one day prior to developing to DHF/DSS. DHF/DSS cases had higher protein levels in urine compared to patients with just dengue fever. Laboratory-based urine protein data, when used together with other readily available blood tests, helped to detect 92% of DHF cases correctly. Currently available clinic-based urine protein test strip was not useful in predicting severe disease. Future studies may improve the ability of the clinic-based tests, thus reducing the reliance on laboratory testing.
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