Assessment of microalbuminuria for early diagnosis and risk prediction in dengue infections.
BACKGROUND
Dengue is the most important arboviral infection of humans. Following an initial febrile period, a small proportion of infected patients develop a vasculopathy, with children at particular risk for severe vascular leakage and shock. Differentiation between dengue and other common childhood illnesses is difficult during the early febrile phase, and risk prediction for development of shock is poor. The presence of microalbuminuria is recognized as a useful early predictor for subsequent complications in a number of other disorders with vascular involvement. Significant proteinuria occurs in association with dengue shock syndrome and it is possible that early-phase microalbuminuria may be helpful both for diagnosis of dengue and for identification of patients likely to develop severe disease.


RESULTS
We measured formal urine albumin to creatinine ratios (UACRs) in daily samples obtained from a large cohort of children with suspected dengue recruited at two outpatient clinics in Ho Chi Minh City, Vietnam. Although UACRs were increased in the 465 confirmed dengue patients, with a significant time trend showing peak values around the critical period for dengue-associated plasma leakage, urine albumin excretion was also increased in the comparison group of 391 patients with other febrile illnesses (OFI). The dengue patients generally had higher UACRs than the OFI patients, but microalbuminuria, using the conventional cutoff of 30 mg albumin/g creatinine discriminated poorly between the two diagnostic groups in the early febrile phase. Secondly UACRs did not prove useful in predicting either development of warning signs for severe dengue or need for hospitalization.


CONCLUSIONS
Low-level albuminuria is common, even in relatively mild dengue infections, but is also present in many OFIs. Simple point-of-care UACR tests are unlikely to be useful for early diagnosis or risk prediction in dengue endemic areas.
Oxford University Clinical Research Unit, Hospital for Tropical Diseases, District 5, Ho Chi Minh City, Vietnam.
Nguyen Thi
NT
Hanh Tien
Phung Khanh
PK
Lam
Huynh Thi Le
HT
Duyen
Tran Van
TV
Ngoc
Phan Thi Thanh
PT
Ha
Nguyen Tan Thanh
NT
Kieu
Cameron
C
Simmons
Marcel
M
Wolbers
Bridget
B
Wills
D000328:Adult; D000418:Albumins / Q000032:analysis*; D000419:Albuminuria / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000652:urine; D003715:Dengue / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000652:urine*; D003716:Dengue Virus / Q000472:pathogenicity; D042241:Early Diagnosis; D005260:Female; D005334:Fever; D006801:Humans; D008297:Male; D014744:Vietnam / Q000453:epidemiology
D000418:Albumins; D003404:Creatinine