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. 2012 Feb;86(2):341-8.
doi: 10.4269/ajtmh.2012.11-0469.

A three-component biomarker panel for prediction of dengue hemorrhagic fever

Allan R Brasier  1 , Hyunsu Ju, Josefina Garcia, Heidi M Spratt, Sundar S Victor, Brett M Forshey, Eric S Halsey, Guillermo Comach, Gloria Sierra, Patrick J Blair, Claudio Rocha, Amy C Morrison, Thomas W Scott, Isabel Bazan, Tadeusz J Kochel; Venezuelan Dengue Fever Working Group
Collaborators, Affiliations

A three-component biomarker panel for prediction of dengue hemorrhagic fever

Allan R Brasier et al. Am J Trop Med Hyg. 2012 Feb.

Abstract

Dengue virus infections are a major cause of morbidity in tropical countries. Early detection of dengue hemorrhagic fever (DHF) may help identify individuals that would benefit from intensive therapy. Predictive modeling was performed using 11 laboratory values of 51 individuals (38 DF and 13 DHF) obtained on initial presentation using logistic regression. We produced a robust model with an area under the curve of 0.9615 that retained IL-10 levels, platelets, and lymphocytes as the major predictive features. A classification and regression tree was developed on these features that were 86% accurate on cross-validation. The IL-10 levels and platelet counts were also identified as the most informative features associated with DHF using a Random Forest classifier. In the presence of polymerase chain reaction-proven acute dengue infections, we suggest a complete blood count and rapid measurement of IL-10 can assist in the triage of potential DHF cases for close follow-up or clinical intervention improving clinical outcome.

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Conflict of interest statement

Disclosure: Josefina Garcia, Eric S. Halsey, Patrick J. Blair, Claudio Rocha, Isabel Bazan, and Tadeusz J. Kochel are military service members or employees of the U.S. Government. This work was prepared as part of their official duties. Title 17 U.S.C. §105 provides that ‘Copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. §101 defines U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person's official duties.

Figures

Figure 1.
Figure 1.
Box plots of differentially expressed laboratory values. Shown are the data for cytokines and laboratory measurements for dengue fever (DF) and dengue hemorrhagic fever (DHF) groups. Horizontal bar, median value; shaded box, 25–75% interquartile range (IQR); error bars, median ± 1.5 (IQR); black circle, outlier.
Figure 2.
Figure 2.
Receiver operating characteristic (ROC) curve for the LR model of dengue hemorrhagic fever (DHF). Shown is an ROC curve for the LR predictive model for DHF. Y axis, sensitivity; X axis, 1-specificity.
Figure 3.
Figure 3.
Classification and regression tree (CART) for prediction of dengue hemorrhagic fever (DHF). Shown is a CART decision tree for classification of DHF. The number of dengue fever (DF) and DHF cases in the study population and their percentage is indicated in each node. Terminal nodes indicated by red.
Figure 4.
Figure 4.
Feature importance analysis using Random Forests. Shown is a variable importance plot for the prediction of dengue hemorrhagic fever (DHF) using Random Forest classifier. Variable importance (X axis) is computed as 100% times the change in the margins averaged over all cases. Abbreviation: L = log2-transformed cytokine concentration.
See this image and copyright information in PMC

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