TY - JOUR
T1 - Association of microvascular function and endothelial biomarkers with clinical outcome in dengue
T2 - An observational study
AU - Yacoub, Sophie
AU - Lam, Phung Khanh
AU - Vu, Le Hoang Mai
AU - Le, Thi Lien
AU - Ha, Ngo Thanh
AU - Toan, Tran Thi
AU - Thu Van, Nguyen
AU - Quyen, Nguyen Than Ha
AU - Duyen, Huynh Thi Le
AU - Van Kinh, Nguyen
AU - Fox, Annette
AU - Mongkolspaya, Juthathip
AU - Wolbers, Marcel
AU - Simmons, Cameron P.
AU - Screaton, Gavin Robert
AU - Wertheim, Heiman
AU - Wills, Bridget
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Background. The hallmark of severe dengue is increased microvascular permeability, but alterations in the microcirculation and their evolution over the course of dengue are unknown. Methods. We conducted a prospective observational study to evaluate the sublingual microcirculation using side-stream darkfield imaging in patients presenting early (<72 hours after fever onset) and patients hospitalized with warning signs or severe dengue in Vietnam. Clinical findings, microvascular function, global hemodynamics assessed with echocardiography, and serological markers of endothelial activation were determined at 4 time points. Results. A total of 165 patients were enrolled. No difference was found between the microcirculatory parameters comparing dengue with other febrile illnesses. The proportion of perfused vessels (PPV) and the mean flow index (MFI) were lower in patients with dengue with plasma than those without leakage (PPV, 88.1% vs 90.6% [P = .01]; MFI, 2.1 vs 2.4 [P = .007]), most markedly during the critical phase. PPV and MFI were correlated with the endothelial activation markers vascular cell adhesion molecule 1 (P < .001 for both) and angiopoietin 2 (P < .001 for both), negatively correlated. Conclusions. Modest microcirculatory alterations occur in dengue, are associated with plasma leakage, and are correlate with molecules of endothelial activation, angiopoietin 2 and vascular cell adhesion molecule 1.
AB - Background. The hallmark of severe dengue is increased microvascular permeability, but alterations in the microcirculation and their evolution over the course of dengue are unknown. Methods. We conducted a prospective observational study to evaluate the sublingual microcirculation using side-stream darkfield imaging in patients presenting early (<72 hours after fever onset) and patients hospitalized with warning signs or severe dengue in Vietnam. Clinical findings, microvascular function, global hemodynamics assessed with echocardiography, and serological markers of endothelial activation were determined at 4 time points. Results. A total of 165 patients were enrolled. No difference was found between the microcirculatory parameters comparing dengue with other febrile illnesses. The proportion of perfused vessels (PPV) and the mean flow index (MFI) were lower in patients with dengue with plasma than those without leakage (PPV, 88.1% vs 90.6% [P = .01]; MFI, 2.1 vs 2.4 [P = .007]), most markedly during the critical phase. PPV and MFI were correlated with the endothelial activation markers vascular cell adhesion molecule 1 (P < .001 for both) and angiopoietin 2 (P < .001 for both), negatively correlated. Conclusions. Modest microcirculatory alterations occur in dengue, are associated with plasma leakage, and are correlate with molecules of endothelial activation, angiopoietin 2 and vascular cell adhesion molecule 1.
KW - Angiopoietin 2
KW - Dengue
KW - Microcirculation
KW - Sidestream dark field imaging
KW - Vascular cell adhesion molecule 1
UR - http://www.scopus.com/inward/record.url?scp=84988985595&partnerID=8YFLogxK
U2 - 10.1093/infdis/jiw220
DO - 10.1093/infdis/jiw220
M3 - Article
AN - SCOPUS:84988985595
VL - 214
SP - 697
EP - 706
JO - The Journal of Infectious Diseases
JF - The Journal of Infectious Diseases
SN - 0022-1899
IS - 5
ER -
