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BACKGROUND: Early detection of complications significantly reduces dengue associated mortality and morbidity. We set out to determine if the NS1 rapid antigen detection test could be used as a point of care test to predict severe disease. METHODS: 186 adult patients with confirmed dengue were enrolled during day 3-8 of illness. Clinical and laboratory parameters were recorded during the course of the illness and NS1 antigen levels were determined using both the Panbio dengue early ELISA (Panbio, Australia) and a NS1 rapid antigen detection kit (SD Bioline, South Korea). RESULTS: 59.1% of patients presented to hospital on day 5-6 of illness when NS1 antigen positivity was significantly (p = 0.008) associated with severe dengue (odds ratio 3.0, 95% CI 1.39 to 6.47) and the NS1 antigen levels were significantly higher (p = 0.03) in those who went on to develop shock. Serum NS1 antigen levels significantly (p < 0.0001) and inversely correlated with the total white cell counts and lymphocyte counts. The bedside NS1 test showed comparable sensitivity (97.4%) and specificity (93.7%) to the laboratory NS1 test in our setting and cohort. CONCLUSION: NS1 antigen positivity is associated with a higher risk of developing severe dengue especially when positive beyond day 5 of illness in our cohort, and while further validation studies are required, the test can therefore potentially be used as a bedside point of care test as a warning sign of severe dengue.

Original publication

DOI

10.1186/s12879-014-0570-8

Type

Journal article

Journal

BMC Infect Dis

Publication Date

31/10/2014

Volume

14

Keywords

Adult, Aged, 80 and over, Antigens, Viral, Area Under Curve, Biomarkers, Dengue Virus, Early Diagnosis, Enzyme-Linked Immunosorbent Assay, Female, Humans, Male, Middle Aged, Pleural Effusion, Point-of-Care Systems, ROC Curve, Sensitivity and Specificity, Severe Dengue, Severity of Illness Index, Viral Nonstructural Proteins, Young Adult