Endotoxin as a predictor of severe dengue infection

Systemic acute inflammatory response in endotoxemia promotes circulating disturbances and enhances prolonged and recurrent shock Study on 120 dengue hemorrhagic fever (DHF) patients was conducted to determine the role of endotoxemia in predicting severe dengue infection. Endotoxin concentration in severe dengue infection was 4 times higher than that in DHF in general. The highest endotoxin level among 32 severe dengue cases belonged to prolonged and recurrent shock cases. Patients with endotoxemia had 5.8 times chance to develop severe dengue infection with shock than than those without endotoxemia. Other predictors for severe dengue infection with shock included time (duration) of shock recovered, fibrinogen concentration, serum C4, and nutritional status; while platelets count was the only predictor for severe dengue infection without shock. Serum endotoxin level of 15 pg/ml was the cut-offpoint of severe dengue infection. In severe dengue infection, better prognosis is characterized by time of shock recovered within 48 minutes, fever ceased within two days, and gastrointestinal bleeding of not more than two days of hospitalization.