Circulating biomarkers predict platelet recovery in adult dengue patients with thrombocytopenia receiving prophylactic platelet transfusion.

OBJECTIVES

Prophylactic platelet transfusion is frequently used in managing hospitalized dengue patients. Our earlier study identified a subset of patients who, despite receiving prophylactic transfusions, exhibited delayed recovery of peripheral platelet counts. This study investigated the underlying mechanisms of this impaired response.

METHODS

We measured cytokine/chemokine concentrations in plasma samples from 197 patients in the multicentre, randomized Adult Dengue Platelet (ADEPT) Study of prophylactic platelet transfusion. Patients were divided into a control group (supportive therapy only) and a transfusion group (supportive therapy plus prophylactic platelet transfusion). Baseline cytokine profiles, along with clinical and biochemical data, were correlated with platelet recovery outcomes.

RESULTS

Plasma cytokine/chemokine levels were similar across both groups at baseline. Poor responders in both groups had higher levels of IL-10 and IL-1RA, while IFN-α, RANTES, SDF-1α, IL-13, and WBC count were specific biomarkers for poor platelet recovery in the transfusion group. These findings suggested cytokine-mediated disruptions in platelet production and increased platelet destruction in poor responders who received platelet transfusions. Decision tree analysis showed that IFN-α, RANTES, and WBC counts predicted platelet recovery with 75% accuracy in transfused patients.

CONCLUSIONS

Our findings highlight that individual differences in immune response exist regardless of transfusion, underscoring the potential for personalized treatment in managing hospitalized adult dengue patients. The identified immune signature suggests that more targeted therapies may benefit patients unlikely to respond to platelet transfusion.