SERUM FERRITIN AS A SEVERITY PREDICTIVE INDICATOR IN CHILDREN WITH DENGUE A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Introduction: Dengue fever, a mosquito-borne viral illness caused by four dengue virus serotypes, poses a significant health burden globally, particularly among children who are vulnerable to severe forms. Early prediction of severe dengue remains challenging. Serum ferritin, an acute-phase reactant, has emerged as a potential biomarker for severity. This study aims to evaluate serum ferritin as an early predictor of severity in pediatric dengue cases. Methodology: A prospective observational study was conducted involving 42 children aged 1–18 years with confirmed dengue infection (NS1 antigen and/or IgM positive) admitted to RL Jalappa Hospital. Clinical data and laboratory investigations, including serum ferritin measured at admission by enhanced chemiluminescence, were collected. Statistical analysis using SPSS v22 included Chi-square, independent t-test, and ROC curve analysis, with significance set at p < 0.05. Results: The study population had a mean age of 10.38 years with a female predominance (59.5%). Initial diagnosis at admission was classified as dengue without warning signs (57.1%), dengue with warning signs (9.5%), and severe dengue (33.3%) based on clinical features. Severe dengue was significantly associated with lower white blood cell counts (p = 0.044) and markedly reduced platelet counts (mean ~35,435 cells/mm³; p = 0.001). Serum ferritin levels showed a strong positive correlation with disease severity: dengue without warning signs (mean ~480 ng/mL), dengue with warning signs (~836 ng/mL), and severe dengue (~1349 ng/mL) (p < 0.001). Hemoglobin and packed cell volume did not differ significantly across severity groups. Conclusion: Serum ferritin is a significant and reliable biomarker for predicting severity in pediatric dengue. Elevated ferritin levels correlate strongly with severe clinical manifestations, reflecting immune activation and plasma leakage. Incorporating serum ferritin measurement into clinical protocols may enhance early identification and management of high-risk pediatric dengue cases. Further standardization of ferritin cutoffs and timing is recommended to optimize clinical utility.