可溶性肿瘤坏死因子受体1预测菲律宾登革热病毒感染儿童和青年的住院治疗

IF 3.7 3区医学 Q2 BIOCHEMISTRY & MOLECULAR BIOLOGY

Cytokine Pub Date : 2025-03-12 DOI:10.1016/j.cyto.2025.156911

Vanesse Li , Hridesh Mishra , Michelle Ngai , Valerie M. Crowley , Vanessa Tran , Maria Salome Siose Painaga , James Yared Gaite , Patrick Hamilton , Andrea L. Conroy , Kevin C. Kain , Michael T. Hawkes

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引用次数: 0

摘要

背景：登革热是热带地区急性发热性疾病的常见病因，少数患者需要住院接受静脉输液治疗。预测哪些患者会发展成严重的疾病是一项挑战。可溶性肿瘤坏死因子受体1 （sTNFR1）与严重登革热相关，可能具有预后价值。方法对菲律宾门诊确诊为NS1抗原血症或IgM血清阳性的登革热患者进行前瞻性队列研究。在入院时测量sTNFR1，并随访患者14-21天，包括住院（主要结局）、住院时间、静脉液体复苏、血液浓缩和血小板减少（次要结局）。结果共纳入244例患者（中位年龄9岁，女性占40%，无并发症登革热占26%，有警示信号登革热占73%，重症登革热占0.82%）。临床表现时sTNFR1血药浓度中位数为3000pg/mL (IQR 2400-3700)，恢复后降至1800 （IQR 1600-2100）。181名患者（74%）需要住院治疗。血浆sTNFR1浓度；2800 pg/mL，临床就诊时测量，与随后的住院相关(相对危险度1.5,95% CI 1.2-1.7, p <；0.0001)。升高的sTNFR1也与更长的住院时间、静脉需水量、血液浓度和血小板减少症有关。sTNFR1还与全身性炎症标志物（降钙素原）和内皮活化循环标志物（Ang2、sTie-2、sVCAM-1和内啡肽）相关。结论sTNFR1升高可预测DENV感染门诊患者后续住院。它有望作为一种标记物，指导分诊，在资源有限的环境中减轻登革热的巨大医疗负担。

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Soluble tumour necrosis factor receptor 1 predicts hospitalization in children and young adults with dengue virus infection in the Philippines

Background

Dengue fever is a common cause of acute febrile illness in the tropics and requires hospitalization for intravenous (IV) fluid therapy in a minority of patients. Predicting which patients will progress to severe disease is challenging. Soluble tumour necrosis factor receptor 1 (sTNFR1) is associated with severe dengue and may have prognostic value.

Methods

Prospective cohort study of outpatients in the Philippines with dengue fever, confirmed by NS1 antigenemia or IgM seropositivity. sTNFR1 was measured at presentation and patients were followed for 14–21 days for hospitalization (primary outcome), duration of stay, IV fluid resuscitation, hemoconcentration, and thrombocytopenia (secondary outcomes).

Results

244 patients (median age 9 years, 40 % female, 26 % uncomplicated dengue, 73 % dengue with warning signs, 0.82 % severe dengue) were included. The median sTNFR1 plasma concentration was 3000pg/mL (IQR 2400–3700) at clinic presentation, decreasing to 1800 (IQR 1600–2100) after recovery. 181 patients (74 %) required hospitalization. Plasma sTNFR1 concentration > 2800 pg/mL, measured at clinic presentation, was associated with subsequent hospitalization (relative risk 1.5, 95 %CI 1.2–1.7, p < 0.0001). Elevated sTNFR1 was also associated with longer duration of stay, IV fluid requirement, hemoconcentration, and thrombocytopenia. sTNFR1 was also associated with a marker of systemic inflammation (procalcitonin), and circulating markers of endothelial activation (Ang2, sTie-2, sVCAM-1, and endoglin).

Conclusion

Elevated sTNFR1 is predictive of subsequent hospitalization among outpatients with DENV infection. It shows promise as a marker that could guide triage to reduce the large healthcare burden of dengue in resource-constrained settings.

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来源期刊

Cytokine 医学-免疫学

CiteScore

7.60

自引率

2.60%

发文量

262

审稿时长

48 days

期刊介绍： The journal Cytokine has an open access mirror journal Cytokine: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. * Devoted exclusively to the study of the molecular biology, genetics, biochemistry, immunology, genome-wide association studies, pathobiology, diagnostic and clinical applications of all known interleukins, hematopoietic factors, growth factors, cytotoxins, interferons, new cytokines, and chemokines, Cytokine provides comprehensive coverage of cytokines and their mechanisms of actions, 12 times a year by publishing original high quality refereed scientific papers from prominent investigators in both the academic and industrial sectors. We will publish 3 major types of manuscripts: 1) Original manuscripts describing research results. 2) Basic and clinical reviews describing cytokine actions and regulation. 3) Short commentaries/perspectives on recently published aspects of cytokines, pathogenesis and clinical results.