Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Department of Preventive Medicine & Biostatistics, Bethesda, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA; King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.
Virginia Commonwealth University, Richmond, VA, USA.
J Infect Public Health. 2020 Jul;13(7):980-984. doi: 10.1016/j.jiph.2020.03.009. Epub 2020 Apr 4.
The usefulness of laboratory tests in the decision-making process with regard to early identification of dengue virus infection has not been widely reported, particularly the aspartate aminotransferase (AST)/platelet count ratio index during a patient's days of illness. The aim of this study was to examine the pattern of the ratio index over the course of illness and identify whether it is a marker of dengue virus infection in dengue patients, as well as to assess the role of other laboratory tests.
A chart review of 205 dengue patients was analyzed using available records of 845 laboratory results within different time intervals or exam dates during the course of illness. We used repeated measures mixed binary logistic regression analyses to model the dengue virus infection, defined as giving at least one positive antibody test (yes/no).
The high risk of dengue virus infection in dengue patients was found in the male gender (adjusted OR=4.316, 95% CI: 1.285-14.498, P=0.018), in patients with a high AST/platelet count ratio index (adjusted OR=1.438, 95% CI: 1.057-1.957, P=0.021), in patients with a low MCV level (adjusted OR=0.815, 95% CI: 0.679-0.978, P=0.028), and in patients with a low ALT level (adjusted OR=0.996, 95% CI: 0.993-0.999, P=0.010).
Laboratory markers, in particular the AST/platelet count ratio index, can be useful for clinicians to strengthen the decision-making process in primary care settings. Furthermore, our model revealed that low MCV and low ALT are predictors of the dengue virus infection, while being a male increases the risk of dengue virus infection. More studies are needed to evaluate the impact of the AST/platelet count ratio index on the severity of dengue fever infection during the onset of symptoms and course of treatment.
实验室检测在早期识别登革热病毒感染方面的决策中的作用尚未得到广泛报道，特别是在患者患病期间的天冬氨酸氨基转移酶（AST）/血小板计数比值指数。本研究旨在检查该比值指数在病程中的变化模式，并确定其是否为登革热患者感染登革热病毒的标志物，以及评估其他实验室检测的作用。
对 205 例登革热患者的病历进行了回顾性分析，分析了 845 份实验室结果在病程中不同时间间隔或检查日期的可用记录。我们使用重复测量混合二项逻辑回归分析来模拟登革热病毒感染，定义为至少有一次抗体检测阳性（是/否）。
男性（调整后的优势比[OR]为 4.316，95%可信区间[CI]：1.285-14.498，P=0.018）、AST/血小板计数比值指数较高（调整后的 OR 为 1.438，95%CI：1.057-1.957，P=0.021）、MCV 水平较低（调整后的 OR 为 0.815，95%CI：0.679-0.978，P=0.028）和 ALT 水平较低（调整后的 OR 为 0.996，95%CI：0.993-0.999，P=0.010）的登革热患者感染登革热病毒的风险较高。
实验室标志物，特别是 AST/血小板计数比值指数，可有助于临床医生在基层医疗机构中加强决策过程。此外，我们的模型表明，低 MCV 和低 ALT 是登革热病毒感染的预测因子，而男性则增加了感染登革热病毒的风险。需要进一步研究来评估 AST/血小板计数比值指数对症状发作和治疗过程中登革热感染严重程度的影响。
