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Could peak proteinuria determine whether patient with dengue fever develop dengue hemorrhagic/dengue shock syndrome? - A prospective cohort study

Farhad F Vasanwala1*, Rukshini Puvanendran1, Stephanie Fook-Chong2, Joo-Ming Ng1, Sufi M Suhail3 and Kheng-Hock Lee1

Author Affiliations

1 Department of Family Medicine and Continuing Care, Singapore General Hospital, Bowyer Block A, Level 2, 169608, Singapore

2 Department of Clinical Research, Singapore General Hospital, Singapore. Block 6, Level 6, 169608, Singapore

3 Department of Renal Medicine, Singapore General Hospital, Singapore. Block 6, Level 6, 169608 Singapore

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BMC Infectious Diseases 2011, 11:212  doi:10.1186/1471-2334-11-212

Published: 5 August 2011



Worldwide there is a need to develop simple effective predictors that can distinguish whether a patient will progress from dengue fever (DF) to life threatening dengue hemorrhagic (DHF) or dengue shock syndrome (DSS). We explored whether proteinuria could be used as such a marker.


We included patients admitted to hospital with suspected dengue fever. Starting at enrollment until discharge, each patient's daily spot urine protein creatinine ratio (UPCR) was measured. We classified those with confirmed dengue infection as DF or DHF (including DSS) based on WHO criteria. Peak and day of onset of proteinuria was compared between both groups.


Compared to those with DF, patients with DHF had significantly higher median peak proteinuria levels (0.56 versus 0.08 g/day; p < 0.001). For patients with DHF, the median day of onset of proteinuria was at 6 days of defervescence, with a range of -2 to +3 days after defervescence. There were three patients with DF who did not have proteinuria during their illness; the five remaining patients with DF had a median day of onset of proteinuria of was at 6 days of defervescence with a range of 0 to +28 days.


Peak UPCR could potentially predict DHF in patients with dengue requiring close monitoring and treatment.