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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.

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Related in: MedlinePlus

Dengue NS1 positivity and severity of clinical disease. A: Aspartate transaminase levels in patients who were NS1 antigen positive and also of those who were NS1 antigen negative at the time of admission. The bar represents the mean. B: Alanine transaminase levels in patients who were NS1 antigen positive and also of those who were NS1 antigen negative at the time of admission. The bar represents the mean. C: Correlation of white cell counts of patients with dengue infection with NS1 antigen levels (Panbio units). p < 0.0001, Spearman’s R: −0.52. D: Correlation of the lowest lymphocytes observed during the course of the illness in patients with dengue infection with NS1 antigen levels (Panbio units). p < 0.0001, Spearman’s R = −0.48. E: Correlation of the lowest neutrophils observed during the course of the illness in patients with dengue infection with NS1 antigen levels (Panbio units). p < 0.0001, Spearman’s R = −0.39.
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Fig2: Dengue NS1 positivity and severity of clinical disease. A: Aspartate transaminase levels in patients who were NS1 antigen positive and also of those who were NS1 antigen negative at the time of admission. The bar represents the mean. B: Alanine transaminase levels in patients who were NS1 antigen positive and also of those who were NS1 antigen negative at the time of admission. The bar represents the mean. C: Correlation of white cell counts of patients with dengue infection with NS1 antigen levels (Panbio units). p < 0.0001, Spearman’s R: −0.52. D: Correlation of the lowest lymphocytes observed during the course of the illness in patients with dengue infection with NS1 antigen levels (Panbio units). p < 0.0001, Spearman’s R = −0.48. E: Correlation of the lowest neutrophils observed during the course of the illness in patients with dengue infection with NS1 antigen levels (Panbio units). p < 0.0001, Spearman’s R = −0.39.

Mentions: Although not significant (p = 0.059), those who went on to develop severe dengue had higher NS1 antigen levels (Panbio units) on day of admission (median 28.02, IQR 1.01 to 51.24 Panbio units) when compared to those who did not develop severe disease (median 2.9, IQR 0.97 to 44.69 Panbio units). Those who were NS1 antigen positive on admission had higher (p = 0.1) AST values (median 130.6, IQR 10.9 to 297.7 IU) than NS1 negative patients (median 93.6, IQR 50.9 to 226.5 IU) but this was not significantly different (Figure 2A). Those who were NS1 antigen positive on admission also had higher (p = 0.05) ALT levels (median 97.5, IQR 45.05 to 187.5 IU) when compared to those who were NS1 negative (median 66.8, IQR 30 to 144.8 IU) (Figure 2B).Figure 2


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)

Dengue NS1 positivity and severity of clinical disease. A: Aspartate transaminase levels in patients who were NS1 antigen positive and also of those who were NS1 antigen negative at the time of admission. The bar represents the mean. B: Alanine transaminase levels in patients who were NS1 antigen positive and also of those who were NS1 antigen negative at the time of admission. The bar represents the mean. C: Correlation of white cell counts of patients with dengue infection with NS1 antigen levels (Panbio units). p < 0.0001, Spearman’s R: −0.52. D: Correlation of the lowest lymphocytes observed during the course of the illness in patients with dengue infection with NS1 antigen levels (Panbio units). p < 0.0001, Spearman’s R = −0.48. E: Correlation of the lowest neutrophils observed during the course of the illness in patients with dengue infection with NS1 antigen levels (Panbio units). p < 0.0001, Spearman’s R = −0.39.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Dengue NS1 positivity and severity of clinical disease. A: Aspartate transaminase levels in patients who were NS1 antigen positive and also of those who were NS1 antigen negative at the time of admission. The bar represents the mean. B: Alanine transaminase levels in patients who were NS1 antigen positive and also of those who were NS1 antigen negative at the time of admission. The bar represents the mean. C: Correlation of white cell counts of patients with dengue infection with NS1 antigen levels (Panbio units). p < 0.0001, Spearman’s R: −0.52. D: Correlation of the lowest lymphocytes observed during the course of the illness in patients with dengue infection with NS1 antigen levels (Panbio units). p < 0.0001, Spearman’s R = −0.48. E: Correlation of the lowest neutrophils observed during the course of the illness in patients with dengue infection with NS1 antigen levels (Panbio units). p < 0.0001, Spearman’s R = −0.39.
Mentions: Although not significant (p = 0.059), those who went on to develop severe dengue had higher NS1 antigen levels (Panbio units) on day of admission (median 28.02, IQR 1.01 to 51.24 Panbio units) when compared to those who did not develop severe disease (median 2.9, IQR 0.97 to 44.69 Panbio units). Those who were NS1 antigen positive on admission had higher (p = 0.1) AST values (median 130.6, IQR 10.9 to 297.7 IU) than NS1 negative patients (median 93.6, IQR 50.9 to 226.5 IU) but this was not significantly different (Figure 2A). Those who were NS1 antigen positive on admission also had higher (p = 0.05) ALT levels (median 97.5, IQR 45.05 to 187.5 IU) when compared to those who were NS1 negative (median 66.8, IQR 30 to 144.8 IU) (Figure 2B).Figure 2

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