Urine Protein/Creatinine Ratio as a Predictor of Disease Severity in Children with Dengue Fever: A Cross-Sectional Study from a Tertiary Care Centre in Tamil Nadu

Abstract

Objective: To correlate urine protein/creatinine ratio (UPCR) with severity of illness in children with dengue fever, and to assess daily UPCR trends as a marker of disease progression. Methods: This cross-sectional observational study was conducted over 18 months at a tertiary care centre in Chengalpattu district, Tamil Nadu. One hundred and thirty children aged 6 months to 18 years with NS1-antigen- or IgM-antibody-confirmed dengue were enrolled; children with pre-existing causes of proteinuria were excluded. Spot urine samples were collected daily until discharge and UPCR calculated. Dengue severity was classified per WHO (2009) criteria into three categories. Data were analysed in SPSS version 17 with a 5% level of significance. Results: Mean age was 8.7 ± 4.75 years, with a slight female predominance (52.31%). Severe dengue was seen in 73.85% of children, dengue with warning signs in 18.46%, and dengue without warning signs in 7.69%. Mean UPCR rose progressively with severity (0.17 ± 0.08, 0.69 ± 0.21, and 2.18 ± 1.86 respectively). UPCR correlated positively with dengue severity (r = +0.41, P = 0.001) and haematocrit (r = +0.42, P = 0.001), and negatively with platelet count (r = −0.21, P = 0.016). Age, sex, and day of illness at presentation were not significantly associated with severity. Conclusion: UPCR is a simple, non-invasive, and inexpensive marker that correlates well with dengue severity in children and may aid early identification of those at risk of severe disease.