Evaluation of inflammatory biomarkers as predictors of disease severity in patients with dengue fever

Abstract

Background

Dengue fever is a major mosquito-borne viral infection with a wide clinical spectrum ranging from uncomplicated febrile illness to severe dengue with plasma leakage, shock, organ dysfunction, and mortality. Early prediction of disease severity remains challenging due to overlapping clinical features during the initial phase. Inflammatory biomarkers may provide valuable insights into immune activation and help identify patients at risk of severe disease.

Objective

To evaluate the association of inflammatory biomarkers with disease severity and assess their predictive role in patients with dengue fever.

Methods

A prospective observational study was conducted among 110 patients with laboratory-confirmed dengue infection. Clinical findings, hematological parameters, biochemical investigations, and inflammatory biomarkers including C-reactive protein (CRP), ferritin, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and interleukin-10 (IL-10) were evaluated. Patients were classified according to disease severity, and biomarker levels were compared between severe and non-severe dengue groups. Receiver operating characteristic (ROC) analysis was performed to determine predictive accuracy.

Results

Among 110 patients, 38 (34.5%) developed severe dengue, while 72 (65.5%) had non-severe disease. Severe dengue patients demonstrated significantly higher levels of inflammatory biomarkers compared with non-severe cases. Ferritin levels were significantly elevated in severe dengue patients (986.4 ± 420.6 ng/mL vs 462.8 ± 238.5 ng/mL; p<0.001), followed by IL-6 (112.5 ± 48.7 pg/mL vs 38.4 ± 18.6 pg/mL; p<0.001) and CRP (28.6 ± 12.4 mg/L vs 14.2 ± 8.6 mg/L; p<0.001). ROC analysis showed ferritin had the highest predictive performance (AUC 0.842), followed by IL-6 (AUC 0.816).

Conclusion

Inflammatory biomarkers, particularly ferritin and IL-6, were significantly associated with severe dengue and demonstrated potential predictive value. Incorporation of these biomarkers with routine clinical parameters may improve early risk stratification and management of patients with dengue fever.