Researchers look at biomarkers which can predict dengue severity

Clinicians cannot reliably predict which of the patients with apparently uncomplicated dengue will suddenly take a turn for the worse and go into haemorrhagic shock. | Photo Credit: REUTERS Dengue has always remained one of the challenging tropical diseases because of the disease’s propensity to suddenly worsen when the patient is apparently recovering. Clinicians cannot reliably predict which of the patients with apparently uncomplicated dengue will suddenly take a turn for the worse and go into haemorrhagic shock.Even though the WHO recommends the monitoring of certain red flags or critical signals such as persistent vomiting, abdominal pain, mucosal bleeding from the nose or gums, lethargy, these warning signs usually appear only after the underlying pathological process has been set in motion.In the last two decades, much global research has gone into understanding and identifying biomarkers (measurable biological indicators) that can predict complications of dengue during the early febrile phase.MoU signedResearchers at the Institute of Advanced Virology in the capital are now engaged in a large prospective study of 2,000 dengue patients to study the critical biomarkers or its combinations that can predict dengue complications and severity. A pilot study using samples from 150 patients has already been completed.They have signed a MoU with three major medical colleges in Kerala – Believers’ Church, Pushpagiri and Government Medical College, Thiruvananthapuram – for screening dengue patient samples and clinical follow-up of patientsIn Kerala, where dengue is hyperendemic and results in huge seasonal outbreaks annually, hospitals tend to get overburdened by fever patients. In such situations, it would be difficult for hospitals to keep all fever patients as in-patients during their apparent recovery phase.“What we need is a clinically usable, affordable prognostic assay that can be used by clinicians on the bedside so that they can easily identify patients who need to be kept in the hospital and monitored. In dengue-endemic regions, this will help the health systems optimise their health resources,” says Agiesh Kumar B, who is leading the IAV research into dengue biomarkers“Plasma leakage is a hallmark process in dengue viral infection that occurs due to the loss of vascular integrity in endothelial cells. Targeting endothelial markers released by activated endothelial cells could serve as effective biomarkers,” he added.“In the pilot study, around 150 dengue patients were screened at three points — on admission, at critical phase and during recovery stage. At each point, a panel of blood proteins was measured” says Dr. Agiesh.The study found that at the time of admission, these markers looked pretty similar across mild, moderate, and severe cases. But at the fever-break stage, both markers spiked sharply. And this spike was far bigger in patients who went on to develop severe dengue compared to milder cases.Using this data and clinical warning signals, a computer model was able to predict which patients would develop severe dengue with close to 100% accuracy.Involves 2,000 patientsThe prospective study being planned in 2,000 patients would be a scaled up version of the pilot study but the researchers would be looking at more than endothelial markers.“We identified some 25 biomarkers and have narrowed it down to a panel of 8 or 10 now, which we will study in detail. We are also teaming up with the National University of Singapore to help us with a computational model for severity prediction.IAV has proposed to indigenously develop a prognostic assay which can be put into a point-of-care device for the use of clinicians, for which we might seek the help of the Department of Science and Technology,” Dr. Agiesh says.The dengue biomarkers study is being taken up with the support of Sreekumar. E, the Director of IAV with bioinformatics support from Abhinand C.S., scientist at the Department of Virus Genomics, Bioinformatics & Statistics, IAV.Clinical coordination of the study is being carried out by C.C. Cleetus, Professor of Biochemistry at Believers Church Medical College, Thiruvalla. Published - July 25, 2026 06:43 pm IST