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Title: Serum chymase levels correlate with severe dengue warning signs and clinical fluid accumulation in hospitalized pediatric patients
Authors: Rathore, Abhay P. S.
Senanayake, Manouri
Athapathu, Arjuna Salinda
Gunasena, Sunethra
Karunaratna, Irantha
Leong, Wei Yee
Lim, Ting
Mantri, Chinmay Kumar
Wilder-Smith, Annelies
St. John, Ashley L.
Keywords: Science::Medicine
Issue Date: 2020
Source: Rathore, A. P. S., Senanayake, M., Athapathu, A. S., Gunasena, S., Karunaratna, I., Leong, W. Y., . . . St. John, A. L. (2020). Serum chymase levels correlate with severe dengue warning signs and clinical fluid accumulation in hospitalized pediatric patients. Scientific Reports, 10, 11856-. doi:10.1038/s41598-020-68844-z
Journal: Scientific Reports 
Abstract: Dengue induces a spectrum of severity in humans from the milder dengue fever to severe disease, or dengue hemorrhagic fever (DHF). Chymase is a candidate biomarker that may aid dengue prognosis. This prospective study aimed to identify whether warning signs of severe dengue, including hypovolemia and fluid accumulation, were associated with elevated chymase. Serum chymase levels were quantified prospectively and longitudinally in hospitalized pediatric dengue patients in Sri Lanka. Warning signs were determined based on daily clinical assessments, laboratory tests and ultrasound findings. Chymase was significantly elevated during the acute phase of disease in DHF or Severe dengue, defined by either the 1997 or 2009 WHO diagnosis guidelines, and persisted longer in the most severe patients. Chymase levels were higher in patients with narrow pulse pressure and clinical warning signs such as severe leakage, fluid accumulation, pleural effusion, gall-bladder wall thickening and rapid haematocrit rise concurrent with thrombocytopenia. No association between chymase and liver enlargement was observed. This study confirms that serum chymase levels are associated with DHF/Severe dengue disease in hospitalized pediatric patients. Chymase levels correlate with warning signs of vascular dysfunction highlighting the possible functional role of chymase in vascular leakage during dengue.
ISSN: 2045-2322
DOI: 10.1038/s41598-020-68844-z
Schools: Lee Kong Chian School of Medicine (LKCMedicine) 
Rights: © 2020 The Author(s). This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit
Fulltext Permission: open
Fulltext Availability: With Fulltext
Appears in Collections:LKCMedicine Journal Articles

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