Bibliographic Details
| Title: |
Higher Plasma Viremia in the Febrile Phase Is Associated With Adverse Dengue Outcomes Irrespective of Infecting Serotype or Host Immune Status: An Analysis of 5642 Vietnamese Cases. |
| Authors: |
Vuong, Nguyen Lam1,2 vuongnl@oucru.org, Quyen, Nguyen Than Ha1, Tien, Nguyen Thi Hanh1, Tuan, Nguyen Minh3, Kien, Duong Thi Hue1, Lam, Phung Khanh1, Tam, Dong Thi Hoai1, Ngoc, Tran Van4, Yacoub, Sophie1,5, Jaenisch, Thomas6, Geskus, Ronald B1,5, Simmons, Cameron P1,5,7, Wills, Bridget A1,5 |
| Source: |
Clinical Infectious Diseases. 6/15/2021, Vol. 72 Issue 12, pe1074-e1083. 10p. |
| Subject Terms: |
*SEROTYPING, *REVERSE transcriptase polymerase chain reaction, *DENGUE, *FEVER, *SEVERITY of illness index, *VIREMIA, *HOSPITAL care, *DESCRIPTIVE statistics, *POLYMERASE chain reaction, *LOGISTIC regression analysis, *ODDS ratio |
| Geographic Terms: |
VIETNAM |
| Abstract: |
Background One of the generally accepted constructs of dengue pathogenesis is that clinical disease severity is at least partially dependent upon plasma viremia, yet data on plasma viremia in primary versus secondary infections and in relation to clinically relevant endpoints remain limited and contradictory. Methods Using a large database comprising detailed clinical and laboratory characterization of Vietnamese participants enrolled in a series of research studies executed over a 15-year period, we explored relationships between plasma viremia measured by reverse transcription–polymerase chain reaction and 3 clinically relevant endpoints—severe dengue, plasma leakage, and hospitalization—in the dengue-confirmed cases. All 4 dengue serotypes and both primary and secondary infections were well represented. In our logistic regression models we allowed for a nonlinear effect of viremia and for associations between viremia and outcome to differ by age, serotype, host immune status, and illness day at study enrollment. Results Among 5642 dengue-confirmed cases we identified 259 (4.6%) severe dengue cases, 701 (12.4%) patients with plasma leakage, and 1441 of 4008 (40.0%) patients recruited in outpatient settings who were subsequently hospitalized. From the early febrile phase onwards, higher viremia increased the risk of developing all 3 endpoints, but effect sizes were modest (ORs ranging from 1.12–1.27 per 1-log increase) compared with the effects of a secondary immune response (ORs, 1.67–7.76). The associations were consistent across age, serotype, and immune status groups, and in the various sensitivity and subgroup analyses we undertook. Conclusions Higher plasma viremia is associated with increased dengue severity, regardless of serotype or immune status. [ABSTRACT FROM AUTHOR] |
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