title: Predictive value of proteinuria in adult dengue severity.
abstract: BACKGROUND
  Dengue is an important viral infection with different presentations. Predicting disease severity is important in triaging patients requiring hospital care. We aim to study the value of proteinuria in predicting the development of dengue hemorrhagic fever (DHF), utility of urine dipstick test as a rapid prognostic tool.
  
  
  RESULTS
  Adult patients with undifferentiated fever (n = 293) were prospectively enrolled at the Infectious Disease Research Clinic at Tan Tock Seng Hospital, Singapore from January to August 2012. Dengue infection was confirmed in 168 (57%) by dengue RT-PCR or NS1 antigen detection. Dengue cases had median fever duration of 6 days at enrollment. DHF was diagnosed in 34 cases according to the WHO 1997 guideline. Dengue fever (DF) patients were predominantly younger and were mostly seen in the outpatient setting with higher platelet level. Compared to DF, DHF cases had significantly higher peak urine protein creatinine ratio (UPCR) during clinical course (26 vs. 40 mg/mmol; p<0.001). We obtained a UPCR cut-off value of 29 mg/mmol based on maximum AUC in ROC curves of peak UPCR for DF versus DHF, corresponding to 76% sensitivity and 60% specificity. Multivariate analysis with other readily available clinical and laboratory variables increased the AUC to 0.91 with 92% sensitivity and 80% specificity. Neither urine dipstick at initial presentation nor peak urine dipstick value during the entire illness was able to discriminate between DF and DHF.
  
  
  CONCLUSIONS
  Proteinuria measured by a laboratory-based UPCR test may be sensitive and specific in prognosticating adult dengue patients.
authors.affiliation: Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore.
authors.forename: Farhad F
authors.initials: FF
authors.lastname: Vasanwala
authors.affiliation: Communicable Disease Center, Tan Tock Seng Hospital, Singapore.
authors.forename: Tun-Linn
authors.initials: TL
authors.lastname: Thein
authors.affiliation: Communicable Disease Center, Tan Tock Seng Hospital, Singapore ; Yong Loo Lin School of Medicine, National University of Singapore, Singapore ; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Yee-Sin
authors.initials: YS
authors.lastname: Leo
authors.affiliation: Communicable Disease Center, Tan Tock Seng Hospital, Singapore.
authors.forename: Victor C
authors.initials: VC
authors.lastname: Gan
authors.affiliation: Communicable Disease Center, Tan Tock Seng Hospital, Singapore.
authors.forename: Ying
authors.initials: Y
authors.lastname: Hao
authors.affiliation: Communicable Disease Center, Tan Tock Seng Hospital, Singapore.
authors.forename: Linda K
authors.initials: LK
authors.lastname: Lee
authors.affiliation: Communicable Disease Center, Tan Tock Seng Hospital, Singapore ; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: David C
authors.initials: DC
authors.lastname: Lye
mesh_terms: D000328:Adult; D019540:Area Under Curve; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011507:Proteinuria / Q000150:complications / Q000453:epidemiology; D012372:ROC Curve; D019595:Severe Dengue / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult