The Urine Protein/Creatinine Ratio as a Tool for Evaluating Proteinuria in the Risk Assessment of Severe Dengue in a Tertiary Care Hospital


Authors : Dr. P. Rajendra Kumar; Dr.V. Sai Avaneesh

Volume/Issue : Volume 10 - 2025, Issue 1 - January


Google Scholar : https://tinyurl.com/ymdhfruy

Scribd : https://tinyurl.com/yvpxw5wv

DOI : https://doi.org/10.5281/zenodo.14854524


Abstract : Background: Dengue fever, caused by the dengue virus and transmitted primarily by Aedes mosquitoes, can lead to severe complications such as Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). Early identification of patients at risk for severe disease is crucial for effective management.  Objective: This study aims to assess the utility of the urine spot protein/creatinine ratio (PCR) as a prognostic tool for predicting the risk of developing DHF and DSS in patients with dengue fever.  Methods: A prospective study was conducted on 100 adult patients diagnosed with dengue fever at Katuri Medical College and Hospital from September 2022 to February 2024. Patients were evaluated for urine spot PCR levels, and clinical outcomes were monitored to determine the incidence of DHF and DSS.  Results: The study found that 25% of patients exhibited proteinuria levels greater than 560 mg/g, with a significant correlation to the development of DHF and DSS. The sensitivity of urine spot PCR for predicting severe dengue was 68.7%, while specificity was 95.5%. The positive predictive value was 88%, and the negative predictive value was 86.6%.  Conclusion: The urine spot protein/creatinine ratio is a valuable prognostic indicator for identifying patients at risk of developing severe dengue complications. Implementing this simple and non-invasive test in clinical practice can enhance early risk stratification and improve patient management in dengue fever cases. Further research is recommended to validate these findings in larger cohorts.

References :

  1. Maria  G.  Guzman,  Scott B.  Halstead,  Harvey Artsob,  Philippe Buchy, Jeremy  Farrar,  Duane  J.  Gubler  et  al.,Dengue:  a  continuing  global threat.Nat Rev Microbiol. 2010;8: S7–S16.
  2. Simmons CP,  Farrar JJ, van Vinh Chau N, Wills B Dengue. 2012 Apr 12;366(15):1423-32. doi: 10.1056/NEJMra1110265
  3. World  Health  Organization  Dengue  Haemorrhagic  Fever:  Diagnosis, Treatment,     Prevention     and     Control.     Geneva:     World Health Organization.1997
  4. Vernon J. Lee,David C.B. Lye,Yan Sun,Gina fernandez,Adrian Ong,Yee Sin  Leo,  Decision  tree  algorithm  in  deciding  hospitalization  for  adult patients with dengue haemorrhagic fever in Singapore. Trop  Med  Int Health 2009; 14:1154–9
  5. Thein  TL,  Leo  YS,  Lee  VJ,  Sun  Y,  Lye  DC  Validation  of  probability equation and decision tree in predicting subsequent dengue hemorrhagic Fever in adult dengue inpatients in singapore. 2011 Nov;85(5):942-5.
  6. James A. Potts, Robert V. Gibbons, Alan L. Rothman, Anon Srikiatkhachorn, Stephen J. Thomas, Pra-on Supradish, Stephenie  C.Lemon,Daniel  H.  Libraty,  Sharone  Green,  Prediction  of dengue   severity   among    patients   using    Early   clinical    Laboratory Indicators. PLoSNegl Trop Dis 2010; 4(8) : e769.
  7. Lai YL, Chung YK, Tan HC, Yap HF, Yap G, et al. Cost- effective realtime reverse transcriptase PCR (RT-PCR) to screen for Dengue virus followed by rapid single-tube multiplex RT-PCR for serotyping of the virus. J Clin Microbiol  2007;  45:935–41.  8.   Keane  WF,   EknoyanG   Proteinuria, albuminuria,  risk,  assessment,  detection,  elimination  (PARADE):  a position  paper  of  the  National  Kidney  Foundation. Am  J  Kidney  D is 1999;33:1004–10.
  8. LeoYS,  GanVC,  NgEL,  HaoY,  NgLC,  et  al.,Utility  of warning  signs  in guiding admission and predicting severe disease in adult dengue. BMC Infect Dis 2013;13: 498.
  9. Wills BA, Oragui EE, Dung NM, Loan HT, Chau NV, Farrar JJ, Levin M. Size  and  charge  characteristics  of the  protein  leak  in  dengue  shock syndrome. Journal of Infectious Diseases. 2004 Aug 15;190(4):810-8
  10. Chen Y, Maguire T, Hileman RE, Fromm JR, Esko JD, Linhardt RJ, Marks RM.  Dengue virus  infectivity depends on envelope  protein  binding to target cell heparan sulfate. Nature medicine. 1997 Aug 1;3(8):866-71.
  11. Bridget A. Wills, Emmanuelle E. Oragui, Nguyen Minh Dung, HaThiLoan, Nguyen Vinh Chau, Jeremy J. Farrar, and Michael Levin Size and charge characteristics of the protein leak in dengue shock syndrome J Infect Dis; 2004; 190 (4): 810-8.
  12. Hanh Tien NT, Lam PK, Duyen HTL, Ngoc TV, Ha PTT, et al. Assessment of Microalbuminuria for Early Diagnosis and Risk Prediction in Dengue Infections. PLoS ONE. 2013; 8(1): e54538
  13. Vasanwala FF, Thein TL, Leo YS, Gan VC, Hao. Y, Lee LK, Lye DC. Predictive value of proteinuria in adult dengue severity. PLoS Negl Trop Dis. 2014 Feb 20;8(2):e2712.
  14. C. Andries et al. / International Journal of Infectious Diseases 55 (2017)38–44
  15. Pok KY, Lai YL, Sng J, Ng LC (2010) Evaluation of nonstructural 1 antigen assays for the diagnosis and surveillance of dengue in Singapore. Vector Borne Zoonotic Dis 10: 1009–1016.
  16. Keane WF, Eknoyan G (1999) Proteinuria, albuminuria, risk, assessment, detection, elimination (PARADE): a position paper of the National Kidney Foundation. Am J Kidney Dis 33: 1004–1010.
  17. Lunn D, Spiegelhalter D, Thomas A, Best N (2009) The BUGS project: Evolution, critique and future directions. Stat Med 28: 3049–3067.
  18. World  Health  Organization  (2009)  Dengue:  guidelines  for  diagnosis, treatment, prevention and control. Geneva: World Health Organization.
  19. Wills BA, Oragui EE, Dung NM, Loan HT, Chau NV, et al. (2004) Size and charge characteristics of the protein leak in dengue shock syndrome. J Infect Dis190: 810–818.
  20. Avirutnan P, Zhang L, Punyadee N, Manuyakorn A, Puttikhunt C, et al. (2007) Secreted NS1 of dengue virus attaches to the surface of cells via interactions with heparan sulfate and chondroitin sulfate E. PLoS Pathog 3: e183.
  21. Blacksell  SD  (2012)  Commercial  Dengue  Rapid  Diagnostic  Tests  for Point-of-  Care Application:  Recent  Evaluations  and  Future  Needs?  J Biomed Biotechnol 2012: 151967.
  22. Green S, Vaughn DW, Kalayanarooj S, Nimmannitya S, Suntayakorn S, et al. (1999) Early immune activation in acute dengue illness is related to development of plasma leakage and disease severity. J Infect Dis 179: 755 – 762
  23. Bethell   DB,  Flobbe  K,  Cao  XT,   Day   NP,  Pham  TP,   et  al.  (1998) Pathophysiologic and prognostic role of cytokines in dengue hemorrhagic fever.J Infect Dis 177: 778–782.
  24. Wang WK, Chen HL, Yang CF, Hsieh SC, Juan CC, et al. (2006) Slower rates of clearance of viral load and virus- containing immune complexes in patients with dengue hemorrhagic fever. Clin Infect Dis 43: 1023–1030.
  25. Libraty  DH,  Young  PR,  Pickering  D,  Endy  TP,  Kalayanarooj  S,  et  al. (2002) High circulating levels of the dengue virus nonstructural protein NS1 early in dengue illness correlate with the development of dengue hemorrhagic fever. J Infect Dis 186: 1165–1168.
  26. Saito  M,  Oishi  K,  Inoue  S,   Dimaano  EM,  Alera  MT,  et  al.   (2004) Association   of   increased   platelet-associated   immunoglobulins   with thrombocytopenia and the severity of disease in secondary dengue virus infections. Clin Exp Immunol 138:299–303.
  27. Kumar Y,  Liang C,  Bo Z, Rajapakse JC, Ooi EE, et al. (2012) Serum Proteome and Cytokine Analysis in a Longitudinal Cohort of Adults with Primary Dengue Infection Reveals Predictive Markers of DHF. PLoS Negl Trop Dis 6: e1887.

Background: Dengue fever, caused by the dengue virus and transmitted primarily by Aedes mosquitoes, can lead to severe complications such as Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). Early identification of patients at risk for severe disease is crucial for effective management.  Objective: This study aims to assess the utility of the urine spot protein/creatinine ratio (PCR) as a prognostic tool for predicting the risk of developing DHF and DSS in patients with dengue fever.  Methods: A prospective study was conducted on 100 adult patients diagnosed with dengue fever at Katuri Medical College and Hospital from September 2022 to February 2024. Patients were evaluated for urine spot PCR levels, and clinical outcomes were monitored to determine the incidence of DHF and DSS.  Results: The study found that 25% of patients exhibited proteinuria levels greater than 560 mg/g, with a significant correlation to the development of DHF and DSS. The sensitivity of urine spot PCR for predicting severe dengue was 68.7%, while specificity was 95.5%. The positive predictive value was 88%, and the negative predictive value was 86.6%.  Conclusion: The urine spot protein/creatinine ratio is a valuable prognostic indicator for identifying patients at risk of developing severe dengue complications. Implementing this simple and non-invasive test in clinical practice can enhance early risk stratification and improve patient management in dengue fever cases. Further research is recommended to validate these findings in larger cohorts.

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