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Elevated soluble thrombomodulin in the febrile stage related to patients at risk for dengue shock syndrome

Punnee Butthep1, Sirichan Chunhakan, Kanchana Tangnararatchakit

  • 1Department of Pathology, Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand. rapbt@mahidol.ac.th

The Pediatric Infectious Disease Journal
|September 29, 2006
PubMed

Insights

Soluble thrombomodulin (sTM) may predict dengue shock syndrome (DSS) in children. Elevated sTM levels were found in patients with severe dengue hemorrhagic fever (DHF) and DSS, indicating potential as an early diagnostic marker.

Area of Science:

  • Infectious Diseases
  • Hematology
  • Vascular Biology

Background:

  • Children with dengue hemorrhagic fever (DHF) are at risk of developing dengue shock syndrome (DSS).
  • Currently, no reliable early markers exist to predict DSS development in DHF patients.

Purpose of the Study:

  • To identify early predictors of dengue shock syndrome (DSS) by investigating markers of vascular endothelial cell injury and dysfunction.
  • To assess the potential of soluble thrombomodulin (sTM) as an early diagnostic marker for DSS.

Main Methods:

  • Blood samples were collected daily from 111 patients with dengue fever, DHF, or other febrile illness (OFI).
  • Samples were analyzed using enzyme-linked immunosorbent assay (ELISA) to measure soluble thrombomodulin (sTM) and other adhesion molecules.
  • Patients were categorized based on disease severity (dengue fever, DHF grades I-IV, OFI) and sample timing relative to defervescence (day 0).

Main Results:

  • Elevated soluble thrombomodulin (sTM) levels were observed in dengue-infected patients compared to OFI.
  • Patients with severe DHF (grades III-IV) and DSS exhibited significantly higher sTM concentrations from day -3 to day +2 relative to defervescence.
  • Increased circulating endothelial cells and adhesion molecules (sVCAM-1, sICAM-1, sE-selectin) were also detected in DSS patients.

Conclusions:

  • Blood soluble thrombomodulin (sTM) shows promise as an early predictor of DSS in dengue-infected patients during the febrile stage.
  • Further large-scale prospective studies are warranted to validate sTM as a reliable early diagnostic marker for DSS.
Abstract

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