1261. Serum Ferritin as a Predictor of Outcome in Dengue Virus Infection
Session: Poster Abstract Session: Travel/Tropical Medicine and Parasitology
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
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  • Background:

    Dengue virus (DENV) infection is the principal cause of arthropod-borne viral disease worldwide. In the early phase, assessment of the prognosis of dengue-related illness remains a challenge to the clinician.

    Methods:

    We evaluated 281 febrile patients, who presented at our emergency department during the 2010-2011 epidemic in Aruba, for DENV infection. A standardized case record form and prespecified laboratory parameters including serum ferritin were used for all patients. A probable diagnosis of dengue was defined according to the 2009 WHO Dengue criteria and hospital admission was indicated when warning signs were present. Outpatients were instructed to have repeat laboratory investigations and come back for review if warning signs developed. Confirmed DENV infection was defined as a) a probable diagnosis of dengue with a positive IgM antibody on day 6-10 of illness, b) a positive NS1 test or c) a positive result in a dengue RNA PCR at any time during illness. We compared serum ferritin levels in confirmed dengue cases with severe versus non-severe disease using the Kruskal-Wallis test.

    Results:

    In 159 of 281 patients DENV infection was confirmed. Of these, 101 were classified as severe and 58 as non-severe. Serum ferritin levels [median (range)] in the severe versus the non-severe cases were significantly higher on day 4 [1580 (43-9204) µg/l] vs. [703  (43-3341) µg/l] and day 5 of illness [1506 (60-17150) µg/l] vs. [328 (43-13571) µg/l] (p <0.05).

    Conclusion:

    High serum ferritin levels at day 4 and 5 of confirmed DENV infection were associated with increased severity of dengue-related illness in an adult population in Aruba. These levels were too high to be explained by ferritin as an acute phase reactant. High ferritin levels, a possible indicator of macrophage activation, may reflect the pivotal role of macrophages and monocytes in dengue pathogenesis. This observation is important because ferritin is readily available in routine chemistry testing. To establish the prognostic value of increased serum ferritin concentrations and their place in clinical management of patients with DENV infection, further studies are warranted.


    Subject Category: T. Travel/tropical medicine and parasitology

    Ralph Huits, MD, Internal Medicine, Dr. Horacio E. Oduber Hospital, Oranjestad, Aruba, Erlijn Tiel Groenestege, MD, Emergency Dept., Dr. Horacio E. Oduber Hospital, Oranjestad, Aruba, Hanna Bouwstra, MD, Dr. Horacio E. Oduber Hospital, Oranjestad, Aruba, Riemsdijk van den Berg, MSc, Microbiology, Landslaboratorium, Oranjestad, Aruba, Eric van Gorp, MD PhD, Virology, Erasmus Medical Center, Rotterdam, Netherlands and Rosalba Brouns, MSc, Clinical Chemistry, Landslaboratorium, Oranjestad, Aruba

    Disclosures:

    R. Huits, None

    E. Tiel Groenestege, None

    H. Bouwstra, None

    R. van den Berg, None

    E. van Gorp, None

    R. Brouns, None

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