Hyperferritinemia in hospitalized children with dengue-a prospective observational study.

Dengue is a major cause of pediatric hospitalization in tropical countries and low- and middle-income countries (LMICs), where early recognition of severe disease remains challenging. Severe dengue is characterized by dysregulated immune activation and systemic inflammation, leading to organ dysfunction. Ferritin, an acute-phase reactant, has been increasingly studied as a potential biomarker of dengue severity, although pediatric data from LMIC settings remain limited. The aim of this study was to assess the prevalence of hyperferritinemia among children admitted with dengue with warning signs and severe dengue, and to correlate ferritin levels with clinical outcomes including organ dysfunction, new-onset multiple organ dysfunction syndrome, thrombocytopenia, need for ventilation, pediatric intensive care unit (PICU) admission, and duration of hospital stay. This single-center prospective observational study included children aged 1 month-18 years admitted to the pediatric ward or PICU with dengue with warning signs or severe dengue over a 6-month period. Serum ferritin was measured at admission. Demographic, clinical, and laboratory data were collected and analyzed. Among the 52 enrolled children, 42 (80.8%) had dengue with warning signs and 10 (19.2%) had severe dengue. Hyperferritinemia was observed in 26/42 (61.9%) children with warning signs and in 9/10 (90%) children with severe dengue. When stratified using a ferritin cutoff of 3000 μg/l, children with ferritin ≥3000 μg/l had significantly lower platelet counts during hospital stay (P-value = .004), increased hematological (P-value = .002) and respiratory dysfunction (P-value = .044), and a higher proportion of severe dengue cases (P-value = .01). Hyperferritinemia is common among hospitalized children with dengue and is associated with thrombocytopenia and organ dysfunction, supporting ferritin as a marker of disease severity.