A study of proteinuria and urine protein-creatinine ratio as a tool in predicting disease severity and adverse outcome in paediatric dengue fever

Abstract

Objectives: Dengue fever presents with a wide spectrum of clinical manifestations, which range from mild febrile illness to severe forms such as dengue haemorrhagic fever and dengue shock syndrome. Early identification of patients who are more likely to develop severe disease is essential for timely intervention and appropriate management. Significant proteinuria has been observed in severe dengue, and this may serve as a useful marker during the early phase of illness. Therefore, the present study aims to evaluate proteinuria and urine protein-creatinine ratio (UPCR) as indicators for predicting the severity of dengue and adverse outcomes in paediatric dengue patients. Material and Methods: Approval from the institutional ethics committee was obtained. Informed consent from the parents of participating subjects was obtained. We conducted a prospective observational study among 90 paediatric patients with positive dengue serology in the inpatient department of a tertiary care centre. On the basis of clinical suspicion of dengue, dengue serology (non-structural protein 1 antigen and immunoglobulin M antibody) and complete blood count were performed. Proteinuria and UPCR were measured daily for 5 days, along with patient vitals. Peak UPCR values were compared with dengue patients without warning signs, with warning signs and severe dengue. Results: A total of 90 children aged between 1 month and 18 years with serologically confirmed dengue were included in the study. The mean age was 7.9 ± 4.5 years, and no significant relationship was found between age and disease severity ( p = 0.698). Males accounted for 55.6% of the cases, and gender was not significantly associated with severity ( p = 0.479). Based on World Health Organization classification, 47.78% of cases were categorised as Category A, 24.44% as Category B and 27.78% as Category C. Proteinuria was absent in 38.89% of children and was more commonly observed in Category A, whereas higher grades (2+ and 3+) were predominantly seen in Category C, showing a significant positive correlation with disease severity (r = 0.35, p = 0.001). The mean peak UPCR was recorded on day 4.04 ± 1.34 of illness. Elevated UPCR levels (>3) were significantly associated with warning signs, hypotension, bleeding manifestations, need for inotropic support, paediatric intensive care unit admission and mortality ( p < 0.001). Overall, increasing UPCR levels were strongly linked to severe dengue and poorer clinical outcomes. Conclusion: Proteinuria and elevated UPCR are significantly associated with severe dengue and adverse clinical outcomes in children. Higher values of peak UPCR and proteinuria were seen in patients in the severe category and those with poorer outcomes. Assessment of urinary protein, especially the UPCR, serves as a valuable marker for determining disease severity in children with dengue. Both proteinuria and UPCR are simple and noninvasive parameters and may aid in early risk stratification; however, further large-scale studies are required to validate their predictive utility.