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Non-invasive Assessment of Microvascular and Endothelial Function
Published on: January 29, 2013
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Microvascular and endothelial function for risk prediction in dengue: an observational study.
Sophie Yacoub1, Heiman Wertheim2, Cameron P Simmons3
1Department of Medicine, Imperial College London, London, UK; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
Lancet (London, England)
|August 28, 2015
Summary
Assessing microvascular and endothelial function in dengue patients reveals dysfunction associated with disease severity. These findings may aid in predicting dengue outcomes and preventing severe complications.
Area of Science:
- Vascular biology and infectious diseases.
- Clinical diagnostics and prognostics.
Background:
- Dengue infection presents a spectrum of illness, with severe cases characterized by increased capillary permeability and potential hypovolemic shock.
- Microvascular and endothelial dysfunction are suspected contributors to hypovolemic shock in dengue but lack clinical assessment.
- This study investigates microvascular assessment as a prognostic tool for dengue.
Purpose of the Study:
- To investigate the clinical utility of microvascular assessment for prognostication in dengue patients.
- To evaluate the association between microvascular and endothelial function and dengue severity.
- To determine if dysfunction precedes severe clinical manifestations.
Main Methods:
- Prospective observational study recruiting 300 participants (children and adults) with suspected dengue.
- Daily clinical assessments for 6 days and a 2-week follow-up.
- Microvascular imaging (sublingual sidestream darkfield imaging) and endothelial function testing (peripheral artery tonometry) at enrollment, defervescence, and follow-up.
Main Results:
- Preliminary data from 167 patients show reduced endothelial function (reactive hyperemia index) in severe dengue and warning sign groups compared to uncomplicated dengue.
- Sidestream darkfield imaging revealed lower perfused vessel proportion and mean flow index during the febrile phase, most pronounced in the severe group.
- Dysfunction was observed prior to the development of severe clinical manifestations.
Conclusions:
- Microvascular and endothelial dysfunction are linked to dengue severity and precede severe clinical signs.
- These functional assessments show potential as prognostic tools for risk prediction in dengue.
- This is the first comprehensive study of vascular function at serial timepoints in dengue.
