A Study on Association of Interleukin-6, Lactate Dehydrogenase, Lactate, Ferritin and Procalcitonin with Severity of Dengue Fever at a Pediatric Tertiary Care Hospital
Anil Kumar Tennelli, Akshay Kumar Deshpande, Spoorthy Nelaji Karunakar, Dastagirsab Mamadapur, Alkarani T. Patil, Basavaraja G V
Author(s)Abstract
Background: Early identification of children at risk of severe dengue is important for timely monitoring and management. Inflammatory and biochemical biomarkers such as interleukin-6 (IL-6), procalcitonin, ferritin, lactate dehydrogenase (LDH), and lactate may have potential roles in assessing disease severity. The objective is to determine the association of IL-6, LDH, lactate, ferritin, and procalcitonin with the severity of dengue fever in children. Material and Methods: This prospective observational study included 155 children aged <18 years with confirmed dengue admitted to a tertiary-care pediatric hospital in Bengaluru over 18 months. IL-6, LDH, lactate, ferritin, and procalcitonin were measured at presentation. Children were subsequently classified as dengue without warning signs, dengue with warning signs, or severe dengue. ROC curve and multivariable logistic regression analyses were performed. Results: Of 155 children, 22 (14.2%) had dengue without warning signs, 103 (66.4%) had dengue with warning signs, and 30 (19.3%) had severe dengue. Procalcitonin, ferritin, and IL-6 increased significantly with disease severity (p<0.001), whereas LDH and lactate did not show significant differences. For differentiating severe dengue from dengue without warning signs, ferritin at a cut-off of 966 had an AUC of 0.96, sensitivity of 90.1%, and specificity of 90.9%; procalcitonin at 0.42 ng/mL had an AUC of 0.95, sensitivity of 90.0%, and specificity of 86.4%; and IL-6 at 8.85 pg/mL had an AUC of 0.94, sensitivity of 90.0%, and specificity of 81.8%. On multivariable analysis, ferritin (AOR 1.04; 95% CI 1.01–1.08; p=0.015) and IL-6 (AOR 2.25; 95% CI 1.39–3.64; p<0.001) remained significantly associated with severe dengue. Conclusion: Ferritin, IL-6, and procalcitonin showed significant associations with dengue severity and good discriminatory performance. Ferritin and IL-6 remained independently associated with severe dengue and may have potential utility as adjunctive biomarkers for early risk stratification in children.
Keywords: Dengue; Severe dengue; Interleukin-6; Ferritin; Procalcitonin; Lactate dehydrogenase; Lactate; Children.