title: Hypocalcemia is associated with disease severity in patients with dengue.
abstract: BACKGROUND
  Dengue hemorrhagic fever (DHF) is a major cause of morbidity and mortality in tropical regions. Serum free calcium (Ca2+) is known to be important in cardiac and circulatory function. We evaluated association between serum Ca2+ level and severity of dengue.
  
  
  METHODS
  A cross-sectional study was carried out at a tertiary care private hospital in Sri Lanka. A probable case of dengue was diagnosed and classified according to World Health Organization criteria and confirmed by either IgM antibody, PCR, or NS1 antigen detection. Socio-demographic details were collected using an interviewer-administered questionnaire.
  
  
  RESULTS
  The sample size was 135. The mean age was 26.1 years, and the majority were males (n = 80, 59.3%). DHF was diagnosed in 71 patients (52.6%). Mean serum Ca2+ level of the study population was 1.05 mmol/L (range 0.77-1.24). Mean serum Ca2+ was significantly higher in patients with dengue fever (DF) (1.09 mmol/L) than in those with DHF (1.02 mmol/L) (p < 0.05). A significant difference was observed between mean serum calcium levels of DHF I and DHF II. Prevalence of hypocalcemia in DHF and DF patients was 86.9% (n = 60) and 29.7% (n = 11), respectively (p < 0.05).
  
  
  CONCLUSIONS
  Serum Ca2+ levels significantly correlated with dengue severity. Serum Ca2+ levels were significantly lower and hypocalcemia was more prevalent in patients with DHF than in patients with DF. Further studies are required to determine whether hypocalcemia can be utilized as a prognostic indicator and to evaluate effectiveness of calcium therapy in prevention of dengue complications.
authors.affiliation: Faculty of Medicine, University of Colombo, Colombo, Sri Lanka. grogerconstantine@gmail.com.
authors.forename: Godwin R
authors.initials: GR
authors.lastname: Constantine
authors.forename: Senaka
authors.initials: S
authors.lastname: Rajapakse
authors.forename: Priyanga
authors.initials: P
authors.lastname: Ranasinghe
authors.forename: Balasundaram
authors.initials: B
authors.lastname: Parththipan
authors.forename: Ananda
authors.initials: A
authors.lastname: Wijewickrama
authors.forename: Priyankara
authors.initials: P
authors.lastname: Jayawardana
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D002648:Child; D003430:Cross-Sectional Studies; D003715:Dengue / Q000150:complications* / Q000473:pathology*; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000473:pathology*; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000097:blood; D012720:Severity of Illness Index; D013188:Sri Lanka; D062606:Tertiary Care Centers; D017361:Viral Nonstructural Proteins / Q000097:blood; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D007075:Immunoglobulin M; D012367:RNA, Viral; D017361:Viral Nonstructural Proteins