Laboratory parameters categorized based on reference ranges among 160 hospitalized adults with dengue.

<p>Laboratory parameters categorized based on reference ranges among 160 hospitalized adults with dengue.</p

Serum Procalcitonin and Peripheral Venous Lactate for Predicting Dengue Shock and/or Organ Failure: A Prospective Observational Study

<div><p>Background</p><p>Currently, there are no biomarkers that can predict the incidence of dengue shock and/or organ failure, although the early identification of risk factors is important in determining appropriate management to reduce mortality. Therefore, we sought to determine the factors associated with dengue shock and/or organ failure and to evaluate the prognostic value of serum procalcitonin (PCT) and peripheral venous lactate (PVL) levels as biomarkers of dengue shock and/or organ failure.</p><p>Methodology/Principal Findings</p><p>A prospective observational study was conducted among adults hospitalized for confirmed viral dengue infection at the Hospital for Tropical Diseases in Bangkok, Thailand between October 2013 and July 2015. Data, including baseline characteristics, clinical parameters, laboratory findings, serum PCT and PVL levels, management, and outcomes, were recorded on pre-defined case report forms. Of 160 patients with dengue, 128 (80.0%) patients had dengue without shock or organ failure, whereas 32 (20.0%) patients developed dengue with shock and/or organ failure. Using a stepwise multivariate logistic regression analysis, PCT ≥0.7 ng/mL (odds ratio [OR]: 4.80; 95% confidence interval [CI]: 1.60–14.45; <i>p</i> = 0.005) and PVL ≥2.5 mmol/L (OR: 27.99, 95% CI: 8.47–92.53; <i>p</i> <0.001) were independently associated with dengue shock and/or organ failure. A combination of PCT ≥0.7 ng/mL and PVL ≥2.5 mmol/L provided good prognostic value for predicting dengue shock and/or organ failure, with an area under the receiver operating characteristics curve of 0.83 (95% CI: 0.74–0.92), a sensitivity of 81.2% (95% CI: 63.6–92.8%), and a specificity of 84.4% (95% CI: 76.9–90.2%). Dengue shock patients with non-clearance of PCT and PVL expired during hospitalization.</p><p>Conclusions/Significance</p><p>PCT ≥0.7 ng/mL and PVL ≥2.5 mmol/L were independently associated with dengue shock and/or organ failure. The combination of PCT and PVL levels could be used as prognostic biomarkers for the prediction of dengue shock and/or organ failure.</p></div

Serum procalcitonin and peripheral venous lactate at admission in dengue patients.

<p>(A) Serum procalcitonin levels among patients with and without dengue shock and/or organ failure. (B) Peripheral venous lactate levels among patients with and without dengue shock and/or organ failure. Data are presented as box and whisker plots with median (horizontal line), interquartile range (box), maximum value within 1.5 of interquartile range (whiskers), outliers (circles), and extreme outliers (asterisks).</p

Flow diagram showing the recruitment of study patients.

<p>ELISA, enzyme-linked immunosorbent assay; RT-PCR, reverse-transcriptase polymerase chain reaction.</p

Daily changes in serum procalcitonin and peripheral venous lactate during hospitalization.

<p>(A) Changes in average serum procalcitonin (ng/mL) levels among patients with and without dengue shock and/or organ failure by survival status. (B) Changes in peripheral venous lactate (mmol/L) levels among patients with and without dengue shock and/or organ failure by survival status. Data are presented as box and whisker plots with median (horizontal line), interquartile range (box), and maximum value within 1.5 of interquartile range (whiskers).</p

Univariate analysis for the prediction of dengue shock and/or organ failure using clinical and laboratory parameters.

<p>Univariate analysis for the prediction of dengue shock and/or organ failure using clinical and laboratory parameters.</p

Baseline characteristics and clinical parameters at admission among 160 hospitalized adults with dengue.

<p>Baseline characteristics and clinical parameters at admission among 160 hospitalized adults with dengue.</p

The prediction of dengue shock and/or organ failure at admission using serum procalcitonin and peripheral venous lactate.

<p>The prediction of dengue shock and/or organ failure at admission using serum procalcitonin and peripheral venous lactate.</p

Multivariate logistic regression analysis for the prediction of dengue shock and/or organ failure using laboratory parameters.

<p>Multivariate logistic regression analysis for the prediction of dengue shock and/or organ failure using laboratory parameters.</p

Baseline characteristics, clinical parameters, laboratory parameters, and outcomes among 162 hospitalized adults with dengue, subdivided by patients with and without dengue shock.

<p>Baseline characteristics, clinical parameters, laboratory parameters, and outcomes among 162 hospitalized adults with dengue, subdivided by patients with and without dengue shock.</p