Study of serum ferritin levels in Dengue patients and its correlation with severity of Dengue virus infection

Aedes aegypti and Aedes albopictus mosquitoes transmit dengue, a significant viral infection and health concern globally . The World Health Organization (WHO) reports nearly 50-100 million new infections annually, with 50,000 severe cases requiring hospitalization and a mortality rate of 2.5percent. The number of cases has surged nearly eight-fold from 505,430 in 2000 to about 5.2 million in 2019. In 2012, WHO labeled dengue as the most significant viral disease spread by mosquitoes. In some rural regions of India, dengue fever has a case fatality rate of 3-5percent. Although it can be managed with simple and inexpensive treatments, the disease can become life-threatening if not diagnosed early. Dengue is known for causing substantial cytokine activation. The four different serotypes of the dengue virus (DV I to IV) can induce symptoms ranging from asymptomatic infection to severe dengue. Dengue fever is suspected when a febrile illness lasting two to seven days includes two or more symptoms such as headache, retro-orbital pain, muscle pain, joint pain, rash, and hemorrhagic presentation. For the first five days of fever, dengue is diagnosed using the NS1 antigen reactivity by enzyme-linked immunosorbent assay (ELISA), which has a diagnostic sensitivity of over 90percent within two to three days of illness onset but decreases significantly after the fifth day. Dengue virus-specific IgM can also be used for diagnosis, with a sensitivity that increases to 50percent after three to five days, 80percent after more than five days, and 100percent after 10 days in individuals who have never been infected with dengue virus . Severe dengue is classified by WHO as dengue hemorrhagic fever and dengue shock syndrome . Since there is no specific treatment for severe dengue, early detection and proper medical care can reduce the fatality rate to below 1percent. To predict severity, several biomarkers for immunological and endothelial cell activity have been established . Dengue infection leads to an increase in acute phase reactants like alpha1 antitrypsin, ceruloplasmin, and ferritin. Ferritin, an iron storage protein complex produced by the reticuloendothelial system, rises in response to infection as the body deprives bacteria of serum iron. Hyperferritinemia, or elevated serum ferritin levels, in dengue patients is associated with severe immunological activation and coagulation issues. Studies have shown that lower serum ferritin levels correlate with better 9 outcomes, and elevated levels are linked to severe dengue fever in children. In a study of 177 children, serum ferritin levels were measured throughout their clinical course, and it was found that levels greater than or equal to 1,200 ng per mL may predict dengue hemorrhagic fever. A study conducted on Aruba Island during a dengue outbreak reported that ferritin can be an effective clinical marker for differentiating dengue from other febrile diseases. Serum ferritin levels exceeding 1,500 ng per mL were associated with severe illness. Therefore, it is vital to constantly monitor patients with hyperferritinemia, as it is linked to significant immunological activation and coagulation issues . It is critical to forecast the risk of severe dengue fever early using basic quantifiable tests, so that necessary, intensive supportive care can be initiated promptly. Our study aimed to determine if serum ferritin measured during the early course of the disease can predict dengue severity, aiding in appropriate triage and management. Additionally, the study aimed to examine the correlation between serum ferritin levels and the duration of hospital stay.

1. Study site Department of General Medicine, Dr DY Patil hospital.
2. Study population: Patients attending OPD and IPD of Department of Medicine.