Biochemical alterations as markers of dengue hemorrhagic fever.

We evaluated biochemical alterations as predictors of dengue hemorrhagic fever (DHF). Patients with confirmed infection with dengue virus were prospectively evaluated for the first seven days of disease to determine their final clinical outcome. Serum samples taken 48-96 hours after onset of fever were used for biochemical tests. Of 199 patients, 30 developed DHF. Cases of DHF had higher levels of lactate dehydrogenase (LDH), creatine kinase (CK), and aspartate aminotransferase, and lower levels of albumin, total cholesterol, and triglycerides. Multivariate analysis showed that early alterations of CK (hazard ratio [HR] = 6.98, 95% confidence interval [CI] = 2.34-20.85, P = 0.001), LDH (HR = 3.19, 95% CI = 1.01-10.12, P < 0.05), and albumin (HR = 2.54, 95% CI = 1.09-5.92, P = 0.03) were associated with DHF. Triglyceride levels > 160 mg/dL were negatively associated with developing DHF (HR = 0.07, 95% CI = 0.01-0.59, P = 0.01). Early alterations of biochemical markers can predict DHF in patients with acute fever caused by dengue.