Serum lactate as predictor and diagnostic biomarker of plasma leakage in adult dengue patients
Abstract: Dengue fever (DF)
and dengue hemorrhagic fever (DHF) are differentiated by the occurrence in DHF
of plasma leakage into the interstitial space as shown by pleural and
peritoneal effusion, hemoconcentration, and intravascular hypovolemia.
Perfusion dysfunction causes anaerobic metabolism, which leads to increased
serum lactate. This study was to determine serum lactate as prognostic predictor
and diagnostic biomarker of plasma leakage in adult dengue patients.
Methods
A cross-sectional retrospective cohort study was conducted on 57 adult
dengue patients hospitalized in the internal medicine ward of Cipto
Mangunkusumo Hospital and Persahabatan Hospital in Jakarta. Serum lactate was
examined to determine its mean difference between DF and DHF. The data was
analyzed by independent t-test and the cut-off points were identified for
presence as well as absence of plasma leakage, then the receiver operating
characteristics (ROC) curve was used to determine sensitivity and specificity.
Results
Mean serum lactate was significantly higher in DHF than in DF. From the
ROC curve, the cut-off point for serum lactate as prognostic predictor on day 3
of fever was ³2.65 mmol/L with AUC of 0.626 (95% CI 0.480-0.772; p=0.108). The
cut-off point for diagnostic biomarker of plasma leakage on day 5 of fever was
2.55 mmol/L with sensitivity 66.6%, specificity 54.2%, and AUC 0.668 (95% CI
0.550-0.826; p=0.016).
Conclusion
There was a significant difference in serum lactate between DF and DHF.
In the critical phase, serum lactate of 2.55 mmol/L could be used as plasma
leakage diagnostic marker of low accuracy.
Keywords: Dengue virus
infection; plasma leakage; serum lactate; adult
Author: Rika Bur, Suhendro
Suwarto, Widayat Djoko Santoso, Kuntjoro Harimurti
Journal Code: jpkedokterangg160214
