Regulators of endothelial integrity as severity predictors in dengue.
BACKGROUND
Dengue is currently among the mosquito-borne diseases of greatest global impact. The clinical course of the disease can be unpredictable, so proper handling in its early stages is critical to ensure optimal outcomes.


OBJECTIVE
To evaluate serum regulators of endothelial integrity (VEGF, sICAM-1, sEndoglina, Ang-1, and Ang-2) as predictive markers of dengue severity.


METHODS
We conducted a case-control study nested in an appropriate cohort. Endothelial regulator levels were first measured by ELISA, after which analysis was performed using logistic regression of clinical and regulatory variables, with severity as an output variable. A possible severity prediction model, based on the variables of interest and output, was defined using the best area under the ROC curve.


RESULTS
The median subject age was 24 years. Severe cases were associated with Ang-2 serum levels of ≥1,490 ng/ml (OR=3.1; p=0.015). Serum levels of Ang-2 (≥1,490 ng/ml) contributed to the severity prediction model, as did a 0.73 area under the ROC curve, together with the variables rash, impaired consciousness and abdominal pain, with an OR of 3.2 (CI 95%: 1.16 to 8.9; p=0.024).


CONCLUSIONS
The endothelial regulator Ang-2 could be a predictor of severity in dengue.
Grupo GERMINA, Departamento de Medicina Interna, Escuela de Medicina, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia. picofigu@hotmail.com.
Claudia Lucía
CL
Figueroa
Margarita
M
Gélvez
Jürg
J
Niederbacher
D042683:Angiopoietin-1 / Q000737:chemistry / Q000235:genetics* / Q000378:metabolism*; D015415:Biomarkers / Q000097:blood*; D016022:Case-Control Studies; D015331:Cohort Studies; D003715:Dengue / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D012372:ROC Curve; D019595:Severe Dengue / Q000097:blood* / Q000378:metabolism
C467630:ANGPT1 protein, human; D042683:Angiopoietin-1; D015415:Biomarkers
Endothelium; capillary permeability; dengue; forecasting; risk; severe dengue