Limits...
Dengue NS1 antigen as a marker of severe clinical disease.

Paranavitane SA, Gomes L, Kamaladasa A, Adikari TN, Wickramasinghe N, Jeewandara C, Shyamali NL, Ogg GS, Malavige GN - BMC Infect. Dis. (2014)

Bottom Line: Early detection of complications significantly reduces dengue associated mortality and morbidity.Serum NS1 antigen levels significantly (p < 0.0001) and inversely correlated with the total white cell counts and lymphocyte counts.The bedside NS1 test showed comparable sensitivity (97.4%) and specificity (93.7%) to the laboratory NS1 test in our setting and cohort.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Early detection of complications significantly reduces dengue associated mortality and morbidity. We set out to determine if the NS1 rapid antigen detection test could be used as a point of care test to predict severe disease.

Methods: 186 adult patients with confirmed dengue were enrolled during day 3-8 of illness. Clinical and laboratory parameters were recorded during the course of the illness and NS1 antigen levels were determined using both the Panbio dengue early ELISA (Panbio, Australia) and a NS1 rapid antigen detection kit (SD Bioline, South Korea).

Results: 59.1% of patients presented to hospital on day 5-6 of illness when NS1 antigen positivity was significantly (p = 0.008) associated with severe dengue (odds ratio 3.0, 95% CI 1.39 to 6.47) and the NS1 antigen levels were significantly higher (p = 0.03) in those who went on to develop shock. Serum NS1 antigen levels significantly (p < 0.0001) and inversely correlated with the total white cell counts and lymphocyte counts. The bedside NS1 test showed comparable sensitivity (97.4%) and specificity (93.7%) to the laboratory NS1 test in our setting and cohort.

Conclusion: NS1 antigen positivity is associated with a higher risk of developing severe dengue especially when positive beyond day 5 of illness in our cohort, and while further validation studies are required, the test can therefore potentially be used as a bedside point of care test as a warning sign of severe dengue.

Show MeSH

Related in: MedlinePlus

NS1 antigen positivity in relation to disease severity. A: Percentage of individuals with severe dengue (SD) and non severe dengue (NSD) who were positive for dengue NS1 antigen detection test by the Panbio NS1 early ELISA. The dark bars represent patients with severe dengue and the lighter bars represent patients with non severe dengue. B: The ROC curves of NS1 antigen levels (Panbio units) as a predictor of shock
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4222370&req=5

Fig1: NS1 antigen positivity in relation to disease severity. A: Percentage of individuals with severe dengue (SD) and non severe dengue (NSD) who were positive for dengue NS1 antigen detection test by the Panbio NS1 early ELISA. The dark bars represent patients with severe dengue and the lighter bars represent patients with non severe dengue. B: The ROC curves of NS1 antigen levels (Panbio units) as a predictor of shock

Mentions: Based on the above disease classification criteria, 52 (55.3%) with severe dengue and 46 (50%) with non severe dengue were positive for NS1 antigen at the time of admission which was not significantly different. 6/9 (66.7%) were positive for NS1 Ag on day 3 of illness, 23/43 (53.5%) on day 4, 45/94 (47.9%) on day 5, 8/17 (47 %) on day 6 and 5/13 (38.4 %) on day 7 and 4/7 (57.1%) on day 8. Patients who proceeded to develop severe dengue were more likely to have a positive NS1 antigen detection test especially during day 5 to 6 of illness (Figure 1A). 35 (63.6%) of those with severe dengue were positive for NS1 Ag between day 5–6 whereas 21 (36.8%) of those with non severe dengue were also positive. Therefore, at the time of typical first presentation to hospital (between day 5 to 6 of illness) NS1 antigen positivity was significantly (p = 0.008) associated with severe dengue (odds ratio 3.0, 95% CI 1.39 to 6.47). The positive predictive value of a NS1 antigen positivity between days 5–6 of illness and development of severe clinical disease was 63.6 (95% confidence interval 49.6 to 76.1) and the negative predictive value was 63.2 (95% confidence interval 49.3 to 75.5).Figure 1


Dengue NS1 antigen as a marker of severe clinical disease.

Paranavitane SA, Gomes L, Kamaladasa A, Adikari TN, Wickramasinghe N, Jeewandara C, Shyamali NL, Ogg GS, Malavige GN - BMC Infect. Dis. (2014)

NS1 antigen positivity in relation to disease severity. A: Percentage of individuals with severe dengue (SD) and non severe dengue (NSD) who were positive for dengue NS1 antigen detection test by the Panbio NS1 early ELISA. The dark bars represent patients with severe dengue and the lighter bars represent patients with non severe dengue. B: The ROC curves of NS1 antigen levels (Panbio units) as a predictor of shock
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4222370&req=5

Fig1: NS1 antigen positivity in relation to disease severity. A: Percentage of individuals with severe dengue (SD) and non severe dengue (NSD) who were positive for dengue NS1 antigen detection test by the Panbio NS1 early ELISA. The dark bars represent patients with severe dengue and the lighter bars represent patients with non severe dengue. B: The ROC curves of NS1 antigen levels (Panbio units) as a predictor of shock
Mentions: Based on the above disease classification criteria, 52 (55.3%) with severe dengue and 46 (50%) with non severe dengue were positive for NS1 antigen at the time of admission which was not significantly different. 6/9 (66.7%) were positive for NS1 Ag on day 3 of illness, 23/43 (53.5%) on day 4, 45/94 (47.9%) on day 5, 8/17 (47 %) on day 6 and 5/13 (38.4 %) on day 7 and 4/7 (57.1%) on day 8. Patients who proceeded to develop severe dengue were more likely to have a positive NS1 antigen detection test especially during day 5 to 6 of illness (Figure 1A). 35 (63.6%) of those with severe dengue were positive for NS1 Ag between day 5–6 whereas 21 (36.8%) of those with non severe dengue were also positive. Therefore, at the time of typical first presentation to hospital (between day 5 to 6 of illness) NS1 antigen positivity was significantly (p = 0.008) associated with severe dengue (odds ratio 3.0, 95% CI 1.39 to 6.47). The positive predictive value of a NS1 antigen positivity between days 5–6 of illness and development of severe clinical disease was 63.6 (95% confidence interval 49.6 to 76.1) and the negative predictive value was 63.2 (95% confidence interval 49.3 to 75.5).Figure 1

Bottom Line: Early detection of complications significantly reduces dengue associated mortality and morbidity.Serum NS1 antigen levels significantly (p < 0.0001) and inversely correlated with the total white cell counts and lymphocyte counts.The bedside NS1 test showed comparable sensitivity (97.4%) and specificity (93.7%) to the laboratory NS1 test in our setting and cohort.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Early detection of complications significantly reduces dengue associated mortality and morbidity. We set out to determine if the NS1 rapid antigen detection test could be used as a point of care test to predict severe disease.

Methods: 186 adult patients with confirmed dengue were enrolled during day 3-8 of illness. Clinical and laboratory parameters were recorded during the course of the illness and NS1 antigen levels were determined using both the Panbio dengue early ELISA (Panbio, Australia) and a NS1 rapid antigen detection kit (SD Bioline, South Korea).

Results: 59.1% of patients presented to hospital on day 5-6 of illness when NS1 antigen positivity was significantly (p = 0.008) associated with severe dengue (odds ratio 3.0, 95% CI 1.39 to 6.47) and the NS1 antigen levels were significantly higher (p = 0.03) in those who went on to develop shock. Serum NS1 antigen levels significantly (p < 0.0001) and inversely correlated with the total white cell counts and lymphocyte counts. The bedside NS1 test showed comparable sensitivity (97.4%) and specificity (93.7%) to the laboratory NS1 test in our setting and cohort.

Conclusion: NS1 antigen positivity is associated with a higher risk of developing severe dengue especially when positive beyond day 5 of illness in our cohort, and while further validation studies are required, the test can therefore potentially be used as a bedside point of care test as a warning sign of severe dengue.

Show MeSH
Related in: MedlinePlus