Serum Cortisol as a Biomarker of Severe Dengue
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Setting
2.2. Study Population
2.3. Measurement of Serum Cortisol
2.4. Statistical Analysis
3. Results
3.1. Serum Cortisol Level
3.2. Serum Cortisol Levels as a Biomarker to Predict Severity of Dengue Infections
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Total n = 265 (100%) | Non-Severe n = 239 (90.2%) | Severe n = 26 (9.8%) | p-Value | |
---|---|---|---|---|
Male, n (%) | 120 (45.3%) | 107 (44.7%) | 13 (50%) | 0.681 |
Age (years), median (IQR) | 17 (13,27.5) | 18 (14.0,28.0) | 13.50 (10.8,24.0) | 0.061 |
Day of fever (day), median (IQR) * | 3 (2, 4) | 3 (2, 4) | 3 (1, 4) | 0.015 |
Pertinent symptoms | ||||
History of vomiting (>2 times) *, n (%) | 48 (18.1%) | 38 (15.9%) | 10 (38.5%) | 0.012 |
Abdominal pain, n (%) | 45 (17%) | 40 (16.7%) | 5 (19.2%) | 0.783 |
Drowsiness, n (%) | 4 (1.5%) | 3 (1.3%) | 1 (3.8%) | 0.340 |
Mucosal bleeding/GI bleeding, n (%) | 23 (8.7%) | 20 (8.4%) | 3 (11.5%) | 0.481 |
Physical Examination | ||||
Body temperature (°C) median (IQR) * | 37.7 (36.9, 38.8) | 37.6 (36.8, 38.7) | 38.7 (37.7, 39.8) | 0.001 |
Systolic blood pressure (mmHg), median (IQR) | 110 (100, 120) | 110 (100, 120) | 110 (100, 120) | 0.822 |
Diastolic blood pressure (mmHg), median (IQR) | 70 (60, 70) | 70 (60, 70) | 70 (60, 80) | 0.140 |
Pulse rate (/min), median (IQR) * | 94 (82, 105) | 92 (80, 104) | 110 (100, 115.50) | <0.0001 |
Respiratory rate (/min), median (IQR) * | 20 (20, 24) | 20 (20, 24) | 24 (20, 28) | 0.001 |
Laboratory findings | ||||
WBC (103/cumm), median (IQR) | 3.20 (2.30, 4.65) | 3.22 (2.30, 4.69) | 3.11 (2.64, 4.45) | 0.298 |
Neutrophil (%), mean (SD) * | 51.41 (18.40) | 50.25 (18.54) | 61.96 (13.16) | 0.002 |
Hb (gm%), mean (SD) | 13.33 (1.81) | 13.36 (1.80) | 13.17 (1.95) | 0.627 |
Hct (%), mean (SD) | 40.16 (5.00) | 40.24 (4.86) | 39.41 (6.15) | 0.420 |
Platelet count 103/cu.mm, median (IQR) | 96.00 (64.00, 148.75) | 96.00 (64.00–146.25) | 105.00 (63.25, 156.75) | 0.285 |
NS1 Ag: Positive, n (%) * | 186 (72.9%) | 162 (70.4%) | 24 (96%) | 0.004 |
IgM: Positive, n (%) * | 148 (55.8%) | 142 (59.4%) | 6 (23.1%) | 0.001 |
IgG: Positive, n (%) * | 158 (59.6%) | 148 (61.9%) | 10 (38.5%) | 0.034 |
Cortisol Cutoff (mcg/dL) | Sensitivity | Specificity | PPV | NPV |
---|---|---|---|---|
15.0 | 0.77 | 0.37 | 0.12 | 0.94 |
18.2 | 0.65 | 0.62 | 0.16 | 0.94 |
25.0 | 0.27 | 0.90 | 0.23 | 0.92 |
Variables | Univariate | Multivariate | ||||
---|---|---|---|---|---|---|
OR | 95% CI | p-Value | OR | 95% CI | p-Value | |
Demographic profile | ||||||
Age | 0.97 | 0.93–1.01 | 0.181 | |||
Gender | 0.82 | 0.36–1.84 | 0.624 | |||
Fever details | ||||||
Day of fever | 0.70 | 0.53–0.93 | 0.015 * | 0.82 | 0.59–1.12 | 0.211 |
Warning signs | ||||||
Abdominal pain or tenderness | 1.18 | 0.42–3.33 | 0.748 | |||
Persistent vomiting | 3.31 | 1.40–7.83 | 0.007 * | 3.68 | 1.42–9.56 | 0.008 * |
Mucosal bleed | 1.43 | 0.39–5.18 | 0.587 | |||
Lethargy, restlessness | 3.15 | 0.32–31.40 | 0.329 | |||
Liver enlargement | 0.00 | 0.000 | - | |||
Lab values on admission | ||||||
White blood cell | 1.00 | 1.00–1.00 | 0.294 | |||
Neutrophil | 1.04 | 1.01–1.06 | 0.003 * | 1.08 | 1.00–1.17 | 0.058 |
Lymphocyte | 0.97 | 0.94–1.00 | 0.029 * | 1.07 | 0.97–1.17 | 0.191 |
Platelets | 1.00 | 1.00–1.00 | 0.131 | |||
Hemoglobin | 0.95 | 0.76–1.18 | 0.626 | |||
Hematocrit | 0.97 | 0.89–1.05 | 0.418 | |||
Aspartate transaminase (AST) | 1.00 | 1.00–1.00 | 0.102 | |||
Alanine aminotransferase (ALT) | 1.00 | 1.00–1.01 | 0.422 | |||
Serum cortisol level (<18.2 vs. ≥18.2 mcg/dL) | 3.13 | 1.34–7.31 | 0.009 * | 2.15 | 0.87–5.34 | 0.098 |
Variable | AUC | p-Value |
---|---|---|
Cortisol | 0.62 | 0.038 * |
Persistent vomiting | 0.61 | 0.055 |
Day of fever | 0.36 | 0.017 * |
Persistent vomiting + Day of fever | 0.69 | 0.010 * |
Persistent vomiting + Cortisol | 0.71 | 0.001 * |
Day of fever + Cortisol | 0.67 | 0.005 * |
Day of fever + Persistent vomiting + Cortisol | 0.74 | <0.001 * |
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Bongsebandhu-phubhakdi, C.; Supornsilchai, V.; Aroonparkmongkol, S.; Limothai, U.; Tachaboon, S.; Dinhuzen, J.; Chaisuriyong, W.; Trongkamolchai, S.; Wanpaisitkul, M.; Chulapornsiri, C.; et al. Serum Cortisol as a Biomarker of Severe Dengue. Trop. Med. Infect. Dis. 2023, 8, 146. https://doi.org/10.3390/tropicalmed8030146
Bongsebandhu-phubhakdi C, Supornsilchai V, Aroonparkmongkol S, Limothai U, Tachaboon S, Dinhuzen J, Chaisuriyong W, Trongkamolchai S, Wanpaisitkul M, Chulapornsiri C, et al. Serum Cortisol as a Biomarker of Severe Dengue. Tropical Medicine and Infectious Disease. 2023; 8(3):146. https://doi.org/10.3390/tropicalmed8030146
Chicago/Turabian StyleBongsebandhu-phubhakdi, Chansuda, Vichit Supornsilchai, Suphab Aroonparkmongkol, Umaporn Limothai, Sasipha Tachaboon, Janejira Dinhuzen, Watchadaporn Chaisuriyong, Supachoke Trongkamolchai, Mananya Wanpaisitkul, Chatchai Chulapornsiri, and et al. 2023. "Serum Cortisol as a Biomarker of Severe Dengue" Tropical Medicine and Infectious Disease 8, no. 3: 146. https://doi.org/10.3390/tropicalmed8030146
APA StyleBongsebandhu-phubhakdi, C., Supornsilchai, V., Aroonparkmongkol, S., Limothai, U., Tachaboon, S., Dinhuzen, J., Chaisuriyong, W., Trongkamolchai, S., Wanpaisitkul, M., Chulapornsiri, C., Tiawilai, A., Tiawilai, T., Tantawichien, T., Thisyakorn, U., & Srisawat, N. (2023). Serum Cortisol as a Biomarker of Severe Dengue. Tropical Medicine and Infectious Disease, 8(3), 146. https://doi.org/10.3390/tropicalmed8030146