The Predictive And Diagnostic Accuracy Of Pentraxin-3 And Vascular Endothelial Growth Factor In Severe Dengue

Low, Gary Kim Kuan (2019) The Predictive And Diagnostic Accuracy Of Pentraxin-3 And Vascular Endothelial Growth Factor In Severe Dengue. PhD thesis, UTAR.

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Abstract

Identifying severe dengue virus infection is essential for prompt management of patients. There is a need to evaluate biomarkers and clinical parameters that can predict the complication. Hence, the biomarkers’ level must be able to predict at least 24 hours prior to the development of complication. Unfortunately, none of the biomarkers were evaluated in a ‘day-to-day’ sequence when the disease progresses. This study aimed to evaluate vascular endothelial growth factor (VEGF) and pentraxin 3 (PTX-3) as predictive and diagnostic markers in differentiating severe dengue from non-severe dengue. The study was conducted in Ampang Health Clinic, Ampang Hospital and Serdang Hospital. The dengue patients were followed up from the day of presentation until discharged. The plasma levels of VEGF and PTX-3 were compared between severe dengue and non-severe dengue by ELISA. The inclusion criteria were participants age 15 or more, presented within the first 72 hours of illness and with positive NS1 Ag test. Multiple logistic regression was used to develop predictive and diagnostic models by incorporating other clinical parameters. The Receiver Operating Characteristics (ROC) analysis was used to assess the accuracy of the biomarkers. A total of 82 patients were recruited, 29 with severe dengue and four died. The Area Under the Curve (AUC) was statistically significant in VEGF as diagnostic marker at Day 2 and 3 of illness with sensitivity of 80.00%- 100.00% and specificity of 76.47%-80.00%. The predictive model with AUC of 0.84 (95% CI: 0.73, 0.94, p < 0.01) has a sensitivity of 100.00% and specificity of 79.25% for predicting severe dengue. The diagnostic model with AUC of 0.71 (95% CI: 0.60, 0.85, p < 0.01) has a sensitivity of 76.19% and specificity of 73.58% for diagnosing severe dengue. The AUC for PTX-3 was not statistically significant. VEGF may be used in combination with other clinical parameters to predict the severity of the disease. As a single biomarker, it may be used as an adjunct investigation to support the diagnosis of severe dengue. PTX-3 was not able to differentiate severe dengue from non-severe dengue.

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