Association of Neutrophil Mediators With Dengue Disease Severity and Cardiac Impairment in Adults

Cardiac function was impaired and levels of myeloperoxidase were higher in patients with severe dengue than in controls or patients with dengue fever during the critical phase. Myeloperoxidase was inversely associated with cardiac function and may mediate dengue-associated cardiac impairment. Background Cardiac impairment contributes to hypotension in severe dengue (SD). However, studies examining pathogenic factors affecting dengue-associated cardiac impairment are lacking. We examined the role of neutrophil mediators on cardiac impairment in clinical dengue. Methods We prospectively enrolled adult patients with dengue and controls. Cardiac parameters were measured using a bioimpedance device. Neutrophils mediators were measured, including myeloperoxidase (MPO) and citrullinated histone H3. Results We recruited 107 dengue patients and 30 controls. Patients with dengue were classified according to World Health Organization 2009 guidelines (44 with dengue fever [DF], 51 with DF with warning signs, and 12 with SD). During critical phase, stroke index (P < .001), cardiac index (P = .03), and Granov-Goor index (P < .001) were significantly lower in patients with dengue than in controls. During critical phase, MPO was significantly higher in patients with dengue than in controls (P < .001) and also significantly higher in patients with SD than in those with DF. In addition, MPO was inversely associated with the stroke, cardiac, and Granov-Goor indexes, during the critical phase, and longitudinally as well. Conclusions Cardiac function was decreased, and MPO increased, during with critical phase in patients SD compared with those with DF and controls. MPO may mediate dengue-associated cardiac impairment.

Automated summary

The study found that cardiac function was impaired and levels of myeloperoxidase were higher in patients with severe dengue, suggesting that myeloperoxidase may mediate dengue-associated cardiac impairment.