Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore.
Communicable Disease Center, Tan Tock Seng Hospital, Singapore.
PLoS Negl Trop Dis. 2014 Feb 20;8(2):e2712. doi: 10.1371/journal.pntd.0002712. eCollection 2014 Feb.
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.
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 enrollment. 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.
Proteinuria measured by a laboratory-based UPCR test may be sensitive and specific in prognosticating adult dengue patients.
登革热是一种具有不同表现的重要病毒感染。预测疾病严重程度对于分诊需要住院治疗的患者非常重要。我们旨在研究蛋白尿在预测登革出血热（DHF）发展中的价值，以及尿液干化学试带检测作为一种快速预后工具的效用。
2012 年 1 月至 8 月，新加坡陈笃生医院传染病研究诊所前瞻性招募了 293 例未分化发热的成年患者。通过登革热 RT-PCR 或 NS1 抗原检测，168 例（57%）确诊为登革热感染。登革热病例在入组时的中位发热持续时间为 6 天。根据世界卫生组织 1997 年指南，诊断为 34 例 DHF。登革热（DF）患者主要为年轻患者，大多在门诊就诊，血小板水平较高。与 DF 相比，DHF 病例在病程中尿蛋白肌酐比（UPCR）峰值明显更高（26 与 40 mg/mmol；p<0.001）。我们根据 DF 与 DHF 之间的最大 AUC 获得了 UPCR 截断值为 29 mg/mmol，其对应敏感性为 76%，特异性为 60%。在具有其他易于获得的临床和实验室变量的多变量分析中，AUC 增加至 0.91，敏感性为 92%，特异性为 80%。在初始表现时的尿液干化学试带检查或整个疾病期间的尿蛋白峰值干化学试带值均无法区分 DF 和 DHF。
基于实验室的 UPCR 检测的蛋白尿可能对预测成年登革热患者的预后具有敏感性和特异性。
