International Journal of Applied Technology in Medical Sciences

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Vol. 4 No. 2 (2025): International Journal of Applied Technology in Medical Sciences

Oxidized HDL as a Novel Predictive Biomarker in Conjunction with Selected Inflammatory Variables in Severe Dengue Fever Patients from Lahore, Pakistan

  • Muhammad Sarwar
  • Noor Kamil
  • Rizwan Ashraf
  • Raahim Ali
  • Rehan Majeed
  • Saba Arif
  • Hassaan B. Sohail
  • Zara Khan
  • Maira Rehan
Submitted
December 5, 2025
Published
2025-12-29

Abstract

Background: Dengue fever is a deadly disease and represents one of the biggest threats to global health, with persisting uncertainty surrounding its prognosis and treatment standards. The onset of severe dengue fever, characterized by intense inflammation and the production of pro-inflammatory molecules, is currently the only well-established association with disease severity. Therefore, identifying and assessing both new and established biomarkers that can accurately predict the outcome of severe dengue fever is essential. Methods: In this study, 100 age-matched healthy controls and 100 hospitalized dengue patients positive for NS1 and IgM, with a mean age of 45 years (range: 22– 65), were examined. Potential biomarkers were analyzed using a Coulter counter, spectroscopy, and ELISA to determine their prognostic value in assessing dengue fever severityResults: Triglycerides and very-low-density lipoproteins (VLDL) were significantly higher in severe dengue fever patients compared to controls (p<0.001). Conversely, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and cholesterol levels were significantly lower in patients compared to controls (p<0.001). Albumin levels were 40.9% lower, lactate dehydrogenase (LDH) was 422.1% higher, and C-reactive protein (CRP) levels were 435.6% higher in severe dengue fever patients compared to controls. Unlike HDL, oxidized HDL (oxHDL) levels were 160.4% higher in patients with severe dengue fever compared to controls. Still, the absolute levels of oxHDL did not exceed total HDL levels, as confirmed by corrected data. Conclusion: Oxidized HDL, combined with other lipoproteins, may provide an ideal panel of prognostic indicators that could guide the treatment of severe dengue fever and serve as reliable biomarkers for predicting disease outcomes

References

  1. Colón-González FJ, Gibb R, Khan K, Watts A, Lowe R, Brady OJ. Projecting the future incidence and burden of dengue in Southeast Asia. Nat Commun 2023; 14(1): 5439. http://dx.doi.org/10.1038/s41467-023-41017-PMID: 37673859 DOI: https://doi.org/10.1038/s41467-023-41017-y
  2. Zerfu B, Kassa T, Legesse M. Epidemiology, biology, pathogenesis, clinical manifestations, and diagnosis of dengue virus infection, and its trend in Ethiopia: A comprehensive literature review. Trop Med Health 2023; 51(1): 11. http://dx.doi.org/10.1186/s41182-023-00504-0PMID: 36829222 DOI: https://doi.org/10.1186/s41182-023-00504-0
  3. Wu B, Qi Z, Qian X. Recent advancements in mosquito- borne flavivirus vaccine development. Viruses 2023; 15(4): 813. http://dx.doi.org/10.3390/v15040813 PMID: 37112794 DOI: https://doi.org/10.3390/v15040813
  4. Ilic I, Ilic M. Global patterns of trends in incidence and mortality of dengue, 1990–2019: An analysis based on the Global Burden of Disease Study. Medicina 2024; 60(3): 425. http://dx.doi.org/10.3390/medicina60030425 PMID: 38541151 DOI: https://doi.org/10.3390/medicina60030425
  5. Rabeya Y, Wasek S. Dengue dynamics: A global update. Adv Hum Biol 2024; 14(1): 5-10. http://dx.doi.org/10.4103/aihb.aihb_135_23 DOI: https://doi.org/10.4103/aihb.aihb_135_23
  6. Afroz R, Das AR, Taha AR, Rahim A, Islam MR. Clinical spectrum and risk factors of severe dengue among hospitalized patients - A cross-sectional study during the 2023 dengue epidemic in Bangladesh. J Med 2024; 25(2): 121-8. http://dx.doi.org/10.3329/jom.v25i2.74291 DOI: https://doi.org/10.3329/jom.v25i2.74291
  7. Vuong NL, Le Duyen HT, Lam PK, et al. C-reactive protein as a potential biomarker for disease progression in dengue: A multi-country observational study. BMC Med 2020; 18(1): 35. http://dx.doi.org/10.1186/s12916-020-1496-1 PMID: 32063229 DOI: https://doi.org/10.1186/s12916-020-1496-1
  8. Thach TQ, Eisa HG, Hmeda AB, et al. Predictive markers for the early prognosis of dengue severity: A systematic review and meta-analysis. PLoS Negl Trop Dis 2021; 15(10): e0009808. http://dx.doi.org/10.1371/journal.pntd.0009808 PMID: 34610027 DOI: https://doi.org/10.1371/journal.pntd.0009808
  9. Shridhar P, Santosh SC, Panda PK, Rijal P. Dengue as an emerging infection and co-infections: An update. Biomed Res 2023; 34(3): 1-5.
  10. Quirino-Teixeira AC, Andrade FB, Pinheiro MBM, Rozini SV, Hottz ED. Platelets in dengue infection: More than a numbers game. Platelets 2022; 33(2): 176-83. http://dx.doi.org/10.1080/09537104.2021.1921722 PMID: 34027810 DOI: https://doi.org/10.1080/09537104.2021.1921722
  11. Mohindra R, K D, Kalyan M, et al. The continuum of liver injury with severity of dengue fever: A retrospective observational study. J R Coll Physicians Edinb 2024; 54(1): 7-13. http://dx.doi.org/10.1177/14782715231216157 PMID: 38112152 DOI: https://doi.org/10.1177/14782715231216157
  12. Sangkaew S, Ming D, Boonyasiri A, et al. Transaminases and serum albumin as early predictors of severe dengue – Authors’ reply. Lancet Infect Dis 2021; 21(11): 1489-90. http://dx.doi.org/10.1016/S1473-3099(21)00624-1 PMID: 34717803 DOI: https://doi.org/10.1016/S1473-3099(21)00624-1
  13. Ishak SH, Yaacob LH, Ishak A. Severe dengue with hemophagocytosis syndrome. Malays Fam Physician 2020; 15(1): 47-9. PMID: 32284805
  14. Bur R, Suwarto S, Pohan HT, et al. Early intervention of 5% albumin shown superior control of vascular integrity and function compared to Ringer’s lactate in hospitalized adults with grade I & II dengue hemorrhagic fever: A multicenter randomized controlled trial in Indonesia. Res Sq 2024. http://dx.doi.org/10.21203/rs.3.rs-4324185/v1 DOI: https://doi.org/10.21203/rs.3.rs-4324185/v1
  15. Marin-Palma D, Sirois CM, Urcuqui-Inchima S, Hernandez JC. Inflammatory status and severity of disease in dengue patients are associated with lipoprotein alterations. PLoS One 2019; 14(3): e0214245.http://dx.doi.org/10.1371/journal.pone.0214245 PMID: 30901375 DOI: https://doi.org/10.1371/journal.pone.0214245
  16. Palanichamy Kala M, St John AL, Rathore APS. Dengue: Update on clinically relevant therapeutic strategies and vaccines. Curr Treat Options Infect Dis 2023; 15(2): 27-52. http://dx.doi.org/10.1007/s40506-023-00263-w PMID: 37124673 DOI: https://doi.org/10.1007/s40506-023-00263-w
  17. Vijay J, Anuradha N, Anbalagan VP. Clinical presentation and platelet profile of dengue fever: A retrospective study. Cureus 2022; 14(8): e28626. http://dx.doi.org/10.7759/cureus.28626 PMID: 36196330 DOI: https://doi.org/10.7759/cureus.28626
  18. Moallemi S, Lloyd AR, Rodrigo C. Early biomarkers for prediction of severe manifestations of dengue fever: A systematic review and a meta-analysis. Sci Rep 2023; 13(1): 17485.http://dx.doi.org/10.1038/s41598-023-44559-9 PMID: 37838744 DOI: https://doi.org/10.1038/s41598-023-44559-9
  19. Hong CG, Florida E, Li H, Parel PM, Mehta NN, Sorokin AV. Oxidized low-density lipoprotein associates with cardiovascular disease by a vicious cycle of atherosclerosis and inflammation: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 9: 1023651. http://dx.doi.org/10.3389/fcvm.2022.1023651 PMID: 36727024 DOI: https://doi.org/10.3389/fcvm.2022.1023651
  20. Itabe H, Obama T. The oxidized lipoproteins in vivo: Its diversity and behavior in the human circulation. Int J Mol Sci 2023; 24(6): 5747. http://dx.doi.org/10.3390/ijms24065747 PMID: 36982815
  21. Kjeld M. An automated colorimetric method for the estimation of lactate dehydrogenase activity in serum. Scand J Clin Lab Invest 1972; 29(4): 421-5.
  22. http://dx.doi.org/10.3109/00365517209080261 PMID: 21488412 DOI: https://doi.org/10.3109/00365517209080261
  23. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18(6): 499-502. http://dx.doi.org/10.1093/clinchem/18.6.499 PMID: 4337382 DOI: https://doi.org/10.1093/clinchem/18.6.499
  24. Shiota T, Li Z, Chen GY, et al. Hepatoviruses promote very- long-chain fatty acid and sphingolipid synthesis for viral RNA replication and quasi-enveloped virus release. Sci Adv 2023; 9(42): eadj4198. http://dx.doi.org/10.1126/sciadv.adj4198 PMID: 37862421 DOI: https://doi.org/10.1126/sciadv.adj4198
  25. Durán A, Carrero R, Parra B, et al. Association of lipid profile alterations with severe forms of dengue in humans. Arch Virol 2015; 160(7): 1687-92. http://dx.doi.org/10.1007/s00705-015-2433-z PMID: 25936955 DOI: https://doi.org/10.1007/s00705-015-2433-z
  26. Välimäki I, Vuorimaa T, Ahotupa M, Vasankari T. Effect of continuous and intermittent exercises on oxidized HDL and LDL lipids in runners. Int J Sports Med 2016; 37(14): 1103-9. http://dx.doi.org/10.1055/s-0042-114703 PMID: 27780284 DOI: https://doi.org/10.1055/s-0042-114703
  27. Suman J, Kumar SR, Sonal S. Biochemical study of certain enzymes in dengue fever patients. Asian J Pharm Clin Res 2020; 13(3): 72-3. http://dx.doi.org/10.22159/ajpcr.2020.v13i3.36711 DOI: https://doi.org/10.22159/ajpcr.2020.v13i3.36711
  28. Akkuş İ, Kaçmaz B. Acute phase reactants. Intercontl J Int Med 2024; 2(3): 74-6. DOI: https://doi.org/10.51271/ICJIM-0040
  29. Kamath SU, Rao R, Nayak S, Pandey AK. Diagnostic performance of C-reactive protein level and its role as a potential biomarker of severe dengue in adults. Asian Pac J Trop Med 2020; 13(8): 358-65.http://dx.doi.org/10.4103/1995-7645.289440 DOI: https://doi.org/10.4103/1995-7645.289440
  30. Berretta M, Quagliariello V, Maurea N, et al. Multiple effects of ascorbic acid against chronic diseases: Updated evidence from preclinical and clinical studies. Antioxidants 2020; 9(12): 1182.
  31. http://dx.doi.org/10.3390/antiox9121182 PMID: 33256059 DOI: https://doi.org/10.3390/antiox9121182
  32. Itabe H, Obama T. The oxidized lipoproteins in vivo: Its diversity and behavior in the human circulation. Int J Mol Sci 2023; 24(6): 5747. DOI: https://doi.org/10.3390/ijms24065747

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