Elevated Serum Chymase as a Risk Factor for Severe Dengue

Abstract

Dengue Virus (DENV) is one of the major viral diseases that has a high burden in Southeast Asia and the Americas. Despite advances in supportive care for mild Dengue Fever (DF) and the more severe Dengue Hemorrhagic Fever (DHF), little is known about how to identify the progression to DHF before it occurs. The purpose of our retrospective study is to assess whether there is an association between the concentration of a serum protein, chymase, with DHF (and the symptoms, pre-existing conditions, and comorbidities associated with it). Data from 291 dengue-confirmed patients were collected from a surveillance study conducted in Sri Lanka. We selected a series of demographic, symptom, and pre-existing condition variables to see if there was an association between these, elevated chymase levels, and a DHF diagnosis. Our results confirmed that the correlation between a DHF diagnosis and increased chymase levels was statistically significant (p = <0.001). Furthermore, the negative correlation between a DF diagnosis and increased chymase levels was significant (p = <0.001). Obesity was also significantly predictive of increased chymase levels (p = <0.001). Elevated chymase levels correlated with (and predicted) a DHF diagnosis between ages 9 and 44, with those under age 9 having the strongest correlation. Overall, an increased chymase level was associated with a DHF diagnosis. The identification of chymase as a biomarker for severe dengue may lead to improved diagnostic and surveillance systems that can identify and treat patients at risk for developing DHF.