@article{oai:nagasaki-u.repo.nii.ac.jp:00001680,
 author = {Phuong, Nguyen Thi Ngoc and Manh, Dao Huy and Dumre, Shyam Prakash and Mizukami, Shusaku and Weiss, Lan Nguyen and Van, Thuong  Nguyen and Ha, Tran Thi Ngoc and Phuc, Le Hong and Van, An  Tran and Tieu, Thuan Minh and Kamel, Mohamed Gomaa and Morra, Mostafa Ebraheem and Huong, Vu Thi Que and Huy, Nguyen Tien and Hirayama, Kenji},
 issue = {1},
 journal = {Annals of Clinical Microbiology and Antimicrobials},
 month = {Mar},
 note = {Background: Considerable progress has been made in dengue management, however the lack of appropriate predictors of severity has led to huge number of unwanted admissions mostly decided on the grounds of warning signs. Apoptosis related mediators,among others, are known to correlate with severe dengue (SD) although no predictive validity is established. The objective of this study was to investigate the association of plasma cell-free DNA (cfDNA) with SD, and evaluate its prognostic value in SD prediction at acute phase. Methods: This was a hospital-based prospective cohort study conducted in Vietnam.All the recruited patients were required to be admitted to the hospital and were strictly monitored for various laboratory and clinical parameters(including progression to SD) until discharged. Plasma samples collected during acute phase (6-48 h before defervescence) were used to estimate the level of cfDNA. Results: Of the 61 dengue patients,SD patients (n = 8)developed shock syndrome in 4.8 days (95% CI 3.7-5.4) after the fever onset. Plasma cfDNA levels
 before the defervescence of SD patients were significantly higher than the non-SD group (p = 0.0493). From the receiver operating characteristic (ROC) curve analysis, a cut-off of > 36.9 ng/mL was able to predict SD with a good sensitivity (87.5%), specificity (54.7%), and area under the curve (AUC) (0.72, 95% CI 0.55-0.88; p = 0.0493).Conclusions: Taken together, these findings suggest that cfDNA could serve as a potential prognostic biomarker of SD. 
Studies with cfDNA kinetics and its combination with other biomarkers and clinical parameters would further improve 
the diagnostic ability for SD., Annals of Clinical Microbiology and Antimicrobials, 18(1), art.no.10; 2019},
 title = {Plasma cell-free DNA: a potential biomarker for early prediction of severe dengue},
 volume = {18},
 year = {2019}
}