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Title: Chymase level is a predictive biomarker of dengue hemorrhagic fever in pediatric and adult patients
Authors: Rathore, Abhay P. S.
Pike, Brian L.
Warkentien, Tyler E.
Farouk, Farouk S.
Gubler, Duane J.
St. John, Ashley L.
Ooi, Eng Eong
Tissera, Hasitha
Leong, Wei Yee
Syenina, Ayesa
Wilder-Smith, Annelies
Keywords: Science::Medicine
Dengue Fever
Dengue Virus
Issue Date: 2017
Source: Tissera, H., Rathore, A. P. S., Leong, W. Y., Pike, B. L., Warkentien, T. E., Farouk, F. S., . . . St. John, A. L. (2017). Chymase level is a predictive biomarker of dengue hemorrhagic fever in pediatric and adult patients. Journal of Infectious Diseases, 216(9), 1112-1121. doi:10.1093/infdis/jix447
Series/Report no.: Journal of Infectious Diseases
Abstract: Background: Most patients with dengue experience mild disease, dengue fever (DF), while few develop the life-threatening diseases dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). No laboratory tests predict DHF or DSS. We evaluated whether the serum chymase level can predict DHF or DSS in adult and pediatric patients and the influence of preexisting conditions (PECs) on chymase levels. Methods: Serum chymase levels were measured in patients presenting with undifferentiated fever to hospitals in Colombo District, Sri Lanka. The value of serum the chymase concentration and clinical signs and symptoms as predictors of DHF and/or DSS was evaluated by multivariate analysis. We assessed the influence of age, PECs, and day after fever onset on the robustness of the chymase level as a biomarker for DHF and/or DSS. Results: An elevated chymase level in acute phase blood samples was highly indicative of later diagnosis of DHF or DSS for pediatric and adult patients with dengue. No recorded PECs prevented an increase in the chymase level during DHF. However, certain PECs (obesity and cardiac or lung-associated diseases) resulted in a concomitant increase in chymase levels among adult patients with DHF. Conclusions: These results show that patients with acute dengue who present with high levels of serum chymase consistently are at greater risk of DHF. The chymase level is a robust prognostic biomarker of severe dengue for adult and pediatric patients.
ISSN: 0022-1899
DOI: 10.1093/infdis/jix447
Rights: © 2017 The Author. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (, which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact
Fulltext Permission: open
Fulltext Availability: With Fulltext
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