血清铁蛋白在预测斯里兰卡登革热成人和儿童血浆渗漏中的作用：一项多中心前瞻性队列研究。

The role of serum ferritin in predicting plasma leakage among adults and children with dengue in Sri Lanka: a multicentre, prospective cohort study.

作者信息

Mettananda Chamila, Perera Kesara, Nayeem Natheeha, Nayanajith Matheesha, Thewage Ayesha, Premaratna Ranjan, Dassanayake Anuradha, Pathmeswaran Arunasalam, Mettananda Sachith

机构信息

Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.

Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.

出版信息

Lancet Reg Health Southeast Asia. 2025 May 28;37:100606. doi: 10.1016/j.lansea.2025.100606. eCollection 2025 Jun.

DOI:10.1016/j.lansea.2025.100606

PMID:40502859

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12155916/

Abstract

BACKGROUND

Early prediction of plasma leakage helps in timely management of dengue. Currently, there are no defined early predictors of plasma leakage, and identified parameters are late predictors. Raised ferritin is associated with severe dengue, but its clinical utility early in the disease to predict severe dengue is not previously reported. We studied the efficacy of day 3 or 4 serum ferritin in predicting plasma leakage among adults and children with dengue in Sri Lanka.

METHODS

We conducted a prospective cohort study in four hospitals in Sri Lanka from June 2022 to June 2023. Consecutive and consenting patients admitted with dengue fever were included in the study. Patients with comorbidities where ferritin could be abnormal were excluded. Serum ferritin levels were prospectively measured daily until day 8 of the illness. Physician-diagnosed plasma leakage, defined as rising haematocrit ≥ 20% from baseline or ultrasound evidence of pleural effusion or ascites, was the main outcome. Data were collected using a proforma by perusing medical records. Prediction of plasma leakage by day 3 or 4 ferritin was studied using receiver operating characteristic curves (ROC).

FINDINGS

We studied 209 patients with dengue, of which 118 (56.5%) were males and median age was 20 years (IQR 9.0-40.5). Out of 209 patients, 70 (33.5%) developed plasma leakage. Median [IQR] ferritin levels on day 3 (926 [400-2752]) and day 4 (1249 [588-3005]) in patients who developed plasma leakage were higher than ferritin levels in patients who did not develop plasma leakage (p < 0.001) (day 3: 273 [101-620]) and (day 4: 506 [220-1226]). Performance of day 3 or 4 ferritin in predicting plasma leakage showed an area under the ROC of 0.78 (95% CI 0.70-0.85). The highest serum ferritin of day 3 or 4 had a positive predictive value of 52% and a negative predictive value of 84%.

INTERPRETATION

Day 3 or 4 ferritin levels correctly predicted plasma leakage status in 78% of the study samples. Serum ferritin levels measured on day 3 or 4 can be used as an early predictor of plasma leakage in dengue.

FUNDING

University of Kelaniya Internal Research Grants 2022 (Grant reference number: RP/03/04/13/01/2022).

摘要

背景

血浆渗漏的早期预测有助于登革热的及时管理。目前，尚无明确的血浆渗漏早期预测指标，已确定的参数均为晚期预测指标。铁蛋白升高与重症登革热相关，但此前尚未报道其在疾病早期预测重症登革热的临床效用。我们研究了第3天或第4天血清铁蛋白在预测斯里兰卡登革热成人和儿童血浆渗漏方面的有效性。

方法

2022年6月至2023年6月，我们在斯里兰卡的四家医院进行了一项前瞻性队列研究。纳入连续且同意参与研究的登革热发热住院患者。排除铁蛋白可能异常的合并症患者。前瞻性地每日测量血清铁蛋白水平，直至发病第8天。主要结局为经医生诊断的血浆渗漏，定义为血细胞比容较基线升高≥20%或有胸腔积液或腹水的超声证据。通过查阅病历使用一份表格收集数据。使用受试者工作特征曲线（ROC）研究第3天或第4天铁蛋白对血浆渗漏的预测情况。

结果

我们研究了209例登革热患者，其中118例（56.5%）为男性，中位年龄为20岁（四分位间距9.0 - 40.5）。在209例患者中，70例（33.5%）发生了血浆渗漏。发生血浆渗漏的患者第3天（926 [400 - 2752]）和第4天（1249 [588 - 3005]）的铁蛋白水平中位数高于未发生血浆渗漏的患者（p < 0.001）（第3天：273 [101 - 620]）和（第4天：506 [220 - 1226]）。第3天或第4天铁蛋白预测血浆渗漏的表现显示ROC曲线下面积为0.78（95%可信区间0.70 - 0.85）。第3天或第4天的最高血清铁蛋白阳性预测值为52%，阴性预测值为84%。