PDF(Pubmed)
Abstract：
Early identification of dengue patients at risk of adverse outcomes is important to prevent hospital overcrowding in low- to middle- income countries during epidemics. We performed a systematic review to identify which biomarkers measured in first 96 h of fever could predict dengue haemorrhagic fever (DHF, World Health Organization 1997 clinical classification) or severe dengue (SD, WHO 2009, clinical classification). PubMed, Scopus, CINAHL, Web of Science, and EMBASE databases were searched for prospective cohort and nested case-control studies published from 1997 to Feb 27, 2022. The protocol for the study was registered in PROSPERO (ID: CRD42021230053). After screening 6747 publications, and analysing 37 eligible studies reporting on 5925 patients, elevated C-reactive protein, aspartate aminotransferase, interleukin-8 and decreased albumin levels were strongly associated with dengue haemorrhagic fever (by meta-analyses of multiple studies, p < 0.05), while elevated vascular cell adhesion protein 1, syndecan-1, aspartate aminotransferase and C-reactive protein levels were strongly associated with severe dengue (by meta-analyses of multiple studies, p < 0.05). Further 44 and 28 biomarkers were associated with the risk of DHF and SD respectively, but only in a single study. The meta-analyses suggest the importance of early acute inflammation with hepatic involvement in determining the subsequent course of illness in dengue.
摘要：
早期识别有不良结局风险的登革热患者对于预防流行病期间中低收入国家的医院过度拥挤是重要的。我们进行了系统评价，以确定在发烧的前96小时测量的哪些生物标志物可以预测登革热出血热（DHF，世界卫生组织1997年临床分类)或严重登革热(SD，世卫组织2009年，临床分类)。PubMed,Scopus,CINAHL,WebofScience,和EMBASE数据库搜索了1997年至2022年2月27日发表的前瞻性队列和嵌套病例对照研究。该研究的方案在PROSPERO(ID:CRD42021230053)中注册。筛选6747种出版物后，并分析了报告5925名患者的37项合格研究，C反应蛋白升高，天冬氨酸转氨酶,白细胞介素-8和白蛋白水平下降与登革出血热密切相关(通过多项研究的荟萃分析,p<0.05)，而升高的血管细胞粘附蛋白1，syndecan-1，天冬氨酸转氨酶和C反应蛋白水平与严重登革热密切相关（通过多项研究的荟萃分析，p<0.05)。另外44和28个生物标志物分别与DHF和SD的风险相关。但仅在一项研究中。荟萃分析表明，早期急性炎症和肝脏受累在确定登革热后续病程中的重要性。
