Jayastu, Senapati (2018) ADAMTS 13 levels and von Willebrand Factor (vWF) collagen activity in Dengue fever: AVID Study. Masters thesis, Christian Medical College, Vellore.
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Abstract
OBJECTIVE: To estimate the levels of ADAMTS 13 levels and vWF activity in adults with dengue fever at presentation and compare it to disease severity. METHODS: This is a prospective observational study conducted in the Departments of Medicine, Medical ICU and Accident and Emergency Medicine at Christian Medical Hospital, Vellore, India from May 2016 to July 2017. Consecutive adult patients with acute febrile illness and thrombocytopenia of less than 1lac/cu mm who also fulfilled the other inclusion and exclusion criteriae were recruited. Sample for ADAMTS 13 and vWF:CBA was collected on day 1 and patients were followed till death, discharge or convalescence. We analysed factors affecting dengue severity by univariate analysis and used logistic regression on these significant factors for multivariate analysis. RESULTS: A total of 62 patients (40 males and 22 females) were recruited. Fifteen patients had non-severe dengue with no warning signs, 36 had non-severe dengue with warning signs and 11 had severe dengue. We clubbed the latter two severity grades into “more severe dengue” and the former as “less severe dengue” for outcome analysis. Though ADAMTS 13 levels did not correlate with disease severity, higher levels of ADAMTS 13 meant lesser transfusion requirement. On multivariate analysis higher SOFA scores on Day 1 was associated with dengue severity. CONCLUSION: The AVID study aimed to look at the role of ADAMTS 13 and its association with severity of dengue infection. We also aimed to look at the association of ADAMTS 13 and transfusion requirement; the difference in their levels in pregnant women with dengue amongst other previously studied parameters. It is the first study in adult dengue patients measuring ADAMTS 13 levels and analyzing its association with disease severity. We also aimed to analyse SOFA score and its correlation to ADAMTS 13 levels in dengue. In our study low levels of ADAMTS 13 were associated with increased transfusion requirement, but not to dengue severity either by W.H.O. grading or by SOFA score. SOFA score on Day 1 showed significant association to W.H.O. grading of dengue severity on multivariate analysis. We used dichotomous outcome variables by clubbing non severe dengue with warning signs and severe dengue into one pool of “more severe dengue” and non sever dengue with no warning sign as “less severe dengue.’ Though we had only 6 pregnant patients, ADAMTS 13 levels were not significant different in them compared to the non-pregnant women. Pregnancy per se did not negatively affect dengue severity. Deficiency of ADAMTS 13 is only one of the many mechanisms implicated in thrombocytopenia of dengue and its possible role in propagating dengue pathogenesis. Its role though appears biologically plausible, needs to be studied in further details to implicate it strongly in dengue. Treatment decisions and transfusion practices will change once a causal relationship between the two is strongly established.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Dengue ; ADAMTS 13 ; vWF collagen activity ; SOFA. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 27 Aug 2018 18:04 |
| Last Modified: | 27 Aug 2018 18:04 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/9390 |
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