Is total serum nitrite and nitrate (NOx) level in dengue patients a potential prognostic marker of dengue hemorrhagic fever?

Abstract

Potential use of total nitrite plus nitrate (NOx) and nitrite (NO2−) separately as surrogate markers for serum nitric oxide in severe dengue and their longitudinal changes along with the progression of infection was studied. Deproteinized sera from confirmed dengue fever (DF, n = 145) and dengue hemorrhagic fever (DHF, n = 74) patients on admission-A, critical-C, discharge-D, and convalescence-CON stages and from age-gender matched healthy individuals (HC, n = 77) were taken to assess NO2− and NOx levels using Griess and modified Griess assays. Serum NOx in DHFA was significantly lower compared to DFA (p < 0 001). HC had the lowest NOx and NO2− compared to all patient categories (p < 0 001) except NO2− in DF-CON and DHF-CON and NOx in DHF-CON. Serum NOx and NO2− in DHF patients admitted on fever day 3 (DHFA-3) was significantly lower compared to DFA-3 (p < 0 05). Cut-off values of 4.46 μM for NOx (91.3% sensitivity and 80.1% specificity) and 1.25 μM for NO2− (75.0% sensitivity and 73.3% specificity) were obtained for day 3 of fever. Serum NOx may be used as potential prognostic marker of DHF in patients presenting with DF in the early stage (on day 3 of fever) of the disease.