Frontiers in pediatrics · 2026
Serum ferritin as an adjunctive marker of dengue severity in the pediatric emergency department.
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Iramain Ricardo, Jara Alfredo, Ortiz Jorge, Cardozo Laura, Morínigo Rocío, Franco Lucía
Аннотация
INTRODUCTION: Hyperferritinemia has been described as a potential marker of disease severity in various conditions, including dengue infection, where it has been associated with worse clinical outcomes.
OBJECTIVE: To evaluate the utility of serum ferritin levels in discriminating dengue with warning signs or severe dengue.
MATERIALS AND METHODS: This single-center prospective cohort study evaluated ferritin levels in relation to disease severity in patients aged 1 month to 17 years. Patients were classified into two groups: non-severe dengue (group 1, without warning signs) and dengue with warning signs or severe dengue (group 2). All cases were laboratory-confirmed by antigen detection or serology and were evaluated in the Pediatric Emergency Department between December 2023 and May 2024.
RESULTS: A total of 142 patients were included, of whom 42.2% were classified as group 1 and 57.8% as group 2. Median ferritin levels were significantly higher in group 2 compared with group 1 [841.5 ng/mL (IQR: 244-1,747) vs. 261.5 ng/mL (IQR: 130-645.5); p = 0.001]. A ferritin cutoff value of 382 ng/mL was associated with dengue with warning signs or severe dengue (39% vs. 14%; p < 0.001; RR: 4.0; 95% CI: 2.0-8.2). The area under the receiver operating characteristic (ROC) curve was 0.67 (95% CI: 0.57-0.75), with a sensitivity and specificity of 67%, a positive predictive value of 60%, and a negative predictive value of 73%. The positive and negative likelihood ratios were 2.0 and 0.49, respectively.
CONCLUSION: Higher ferritin levels were observed in patients with dengue with warning signs or severe dengue. Although a cutoff value of ≥382 ng/mL was associated with this composite outcome, its discriminatory performance was limited. Ferritin may serve as an adjunctive biomarker but should not be used as a standalone predictor of disease severity in pediatric dengue.
OBJECTIVE: To evaluate the utility of serum ferritin levels in discriminating dengue with warning signs or severe dengue.
MATERIALS AND METHODS: This single-center prospective cohort study evaluated ferritin levels in relation to disease severity in patients aged 1 month to 17 years. Patients were classified into two groups: non-severe dengue (group 1, without warning signs) and dengue with warning signs or severe dengue (group 2). All cases were laboratory-confirmed by antigen detection or serology and were evaluated in the Pediatric Emergency Department between December 2023 and May 2024.
RESULTS: A total of 142 patients were included, of whom 42.2% were classified as group 1 and 57.8% as group 2. Median ferritin levels were significantly higher in group 2 compared with group 1 [841.5 ng/mL (IQR: 244-1,747) vs. 261.5 ng/mL (IQR: 130-645.5); p = 0.001]. A ferritin cutoff value of 382 ng/mL was associated with dengue with warning signs or severe dengue (39% vs. 14%; p < 0.001; RR: 4.0; 95% CI: 2.0-8.2). The area under the receiver operating characteristic (ROC) curve was 0.67 (95% CI: 0.57-0.75), with a sensitivity and specificity of 67%, a positive predictive value of 60%, and a negative predictive value of 73%. The positive and negative likelihood ratios were 2.0 and 0.49, respectively.
CONCLUSION: Higher ferritin levels were observed in patients with dengue with warning signs or severe dengue. Although a cutoff value of ≥382 ng/mL was associated with this composite outcome, its discriminatory performance was limited. Ferritin may serve as an adjunctive biomarker but should not be used as a standalone predictor of disease severity in pediatric dengue.