Limits...
Increased Serum Hyaluronic Acid and Heparan Sulfate in Dengue Fever: Association with Plasma Leakage and Disease Severity

View Article: PubMed Central - PubMed

ABSTRACT

Plasma leakage is a major pathogenic mechanism of severe dengue, but the etiology remains unclear. The association between endothelial glycocalyx integrity and vascular permeability in older adults with dengue has not been evaluated. A prospective cohort study of adults with undifferentiated fever screened for dengue by RT-PCR or NS1 antigen testing was performed. Patients were assessed daily while symptomatic and at convalescence. Serum hyaluronic acid (HA), heparan sulfate (HS) and selected cytokines (TNF-α, IL-6, IL-10) were measured on enrollment and convalescence. Patients were diagnosed as dengue fever (DF, n = 30), dengue hemorrhagic fever (DHF, n = 20) and non-dengue (ND) febrile illness (n = 11). Acute HA and HS levels were significantly higher in all dengue patients compared to ND (p = 0.0033 and p = 0.0441 respectively), but not different between DF and DHF (p = 0.3426 and p = 0.9180 respectively). Enrolment HA inversely correlated with serum albumin, protein and platelets in all dengue and DHF (p < 0.05). HA and HS in all dengue patients decreased significantly at convalescence. Serum IL-10 was significantly associated with HA in all dengue patients (p = 0.002). Serum HA and HS levels were increased in adult dengue and HA was associated with markers of disease severity. Endothelial glycocalyx damage may have a role in vascular leakage in dengue.

No MeSH data available.


Related in: MedlinePlus

Serum heparan sulfate (HS) levels in dengue subgroups: (a) Acute serum HS in all dengue and non-dengue patients (median, IQR; one outlier omitted in each of all dengue and non-dengue groups), (b) Acute serum HS in non-dengue, DF and DHF subgroups (median, IQR; one outlier omitted in each of the DF and non-dengue groups), (c) Acute serum HS in dengue primary and secondary infection (median, IQR; one outlier omitted in secondary infection), (d) Acute serum HS with respect to day of illness (median, IQR; one outlier omitted at the fourth day of illness.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5385535&req=5

f3: Serum heparan sulfate (HS) levels in dengue subgroups: (a) Acute serum HS in all dengue and non-dengue patients (median, IQR; one outlier omitted in each of all dengue and non-dengue groups), (b) Acute serum HS in non-dengue, DF and DHF subgroups (median, IQR; one outlier omitted in each of the DF and non-dengue groups), (c) Acute serum HS in dengue primary and secondary infection (median, IQR; one outlier omitted in secondary infection), (d) Acute serum HS with respect to day of illness (median, IQR; one outlier omitted at the fourth day of illness.

Mentions: Acute serum HS levels were significantly higher in all dengue patients compared to the ND group p = 0.0441 (Fig. 3a), but there was no significant difference between the DF and DHF patients (p = 0.9180, Fig. 3b). There were also no significant differences between DF and DHF patients enrolled on the third, fourth or fifth day of illness when analyzed by day of illness. No significant difference in HS levels was seen between primary and secondary DENV infections (p = 0.18) (Fig. 3c). There was no significant increase in HS level among the third, fourth and fifth day of illness (p = 0.33, Fig. 3d). However, there was also a significant decrease between acute and convalescent HS levels in both DF and DHF groups (p < 0.001) (Fig. 3c and d), but not in the non-dengue group (p = 0.5564).


Increased Serum Hyaluronic Acid and Heparan Sulfate in Dengue Fever: Association with Plasma Leakage and Disease Severity
Serum heparan sulfate (HS) levels in dengue subgroups: (a) Acute serum HS in all dengue and non-dengue patients (median, IQR; one outlier omitted in each of all dengue and non-dengue groups), (b) Acute serum HS in non-dengue, DF and DHF subgroups (median, IQR; one outlier omitted in each of the DF and non-dengue groups), (c) Acute serum HS in dengue primary and secondary infection (median, IQR; one outlier omitted in secondary infection), (d) Acute serum HS with respect to day of illness (median, IQR; one outlier omitted at the fourth day of illness.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5385535&req=5

f3: Serum heparan sulfate (HS) levels in dengue subgroups: (a) Acute serum HS in all dengue and non-dengue patients (median, IQR; one outlier omitted in each of all dengue and non-dengue groups), (b) Acute serum HS in non-dengue, DF and DHF subgroups (median, IQR; one outlier omitted in each of the DF and non-dengue groups), (c) Acute serum HS in dengue primary and secondary infection (median, IQR; one outlier omitted in secondary infection), (d) Acute serum HS with respect to day of illness (median, IQR; one outlier omitted at the fourth day of illness.
Mentions: Acute serum HS levels were significantly higher in all dengue patients compared to the ND group p = 0.0441 (Fig. 3a), but there was no significant difference between the DF and DHF patients (p = 0.9180, Fig. 3b). There were also no significant differences between DF and DHF patients enrolled on the third, fourth or fifth day of illness when analyzed by day of illness. No significant difference in HS levels was seen between primary and secondary DENV infections (p = 0.18) (Fig. 3c). There was no significant increase in HS level among the third, fourth and fifth day of illness (p = 0.33, Fig. 3d). However, there was also a significant decrease between acute and convalescent HS levels in both DF and DHF groups (p < 0.001) (Fig. 3c and d), but not in the non-dengue group (p = 0.5564).

View Article: PubMed Central - PubMed

ABSTRACT

Plasma leakage is a major pathogenic mechanism of severe dengue, but the etiology remains unclear. The association between endothelial glycocalyx integrity and vascular permeability in older adults with dengue has not been evaluated. A prospective cohort study of adults with undifferentiated fever screened for dengue by RT-PCR or NS1 antigen testing was performed. Patients were assessed daily while symptomatic and at convalescence. Serum hyaluronic acid (HA), heparan sulfate (HS) and selected cytokines (TNF-&alpha;, IL-6, IL-10) were measured on enrollment and convalescence. Patients were diagnosed as dengue fever (DF, n&thinsp;=&thinsp;30), dengue hemorrhagic fever (DHF, n&thinsp;=&thinsp;20) and non-dengue (ND) febrile illness (n&thinsp;=&thinsp;11). Acute HA and HS levels were significantly higher in all dengue patients compared to ND (p&thinsp;=&thinsp;0.0033 and p&thinsp;=&thinsp;0.0441 respectively), but not different between DF and DHF (p&thinsp;=&thinsp;0.3426 and p&thinsp;=&thinsp;0.9180 respectively). Enrolment HA inversely correlated with serum albumin, protein and platelets in all dengue and DHF (p&thinsp;&lt;&thinsp;0.05). HA and HS in all dengue patients decreased significantly at convalescence. Serum IL-10 was significantly associated with HA in all dengue patients (p&thinsp;=&thinsp;0.002). Serum HA and HS levels were increased in adult dengue and HA was associated with markers of disease severity. Endothelial glycocalyx damage may have a role in vascular leakage in dengue.

No MeSH data available.


Related in: MedlinePlus