C-reactive protein may be a useful biomarker for early dengue risk prediction

  • Vuong NL & al.
  • BMC Med
  • 17 Feb 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • C-reactive protein (CRP) within the first 3 days of illness may be a useful biomarker for early prediction of dengue risk and may help in differentiating dengue from other febrile illnesses (OFIs).

Why this matters

  • Findings provide insight into the association between higher CRP and risk for dengue progression, with results generalisable across wide range of populations most commonly affected.

Study design

  • A nested case-control study included 281 patients with severe/intermediate dengue (cases) who were compared (1:3) with 836 uncomplicated dengue patients (controls) and with 394 patients with OFIs.
  • Funding: The World Health Organization, UNICEF/UNDP/World Bank/WHO Special Programme for Research and others.

Key results

  • Median of CRP level within the first 3 days was 30.2 (interquartile range [IQR], 12.4-61.2) mg/L, 28.6 (IQR, 10.5-58.9) mg/L and 34.0 (IQR, 17.4-71.8) mg/L for confirmed, uncomplicated and severe or intermediate dengue, respectively.
  • Higher CRP levels in the first 3 days of illness were associated with a higher risk for severe or intermediate dengue (OR, 1.17; 95% CI, 1.07-1.29) in children.
  • In adults, higher CRP levels ≥30 mg/L were linked to hospitalisation (OR, 1.37; 95% CI, 1.14-1.64) and longer fever clearance time (HR, 0.84; 95% CI, 0.76-0.93).
  • CRP levels were higher in patients with dengue vs those with probable viral infection (P=.003) but lower than in patients with probable bacterial infection (P<.001>
  • CRP levels were positively associated with total white cell count and neutrophils (Pearson’s correlation coefficients, 0.25 and 0.3, respectively), and negatively with lymphocytes (Pearson’s correlation coefficients, −0.36)
  • No significant association was observed between CPR levels and liver transaminases, albumin and platelet nadir.

Limitations

  • Risk of bias and confounding.