Observational studyClinical infectious diseases : an official publication of the Infectious Diseases Society of America2017
Endothelial Nitric Oxide Pathways in the Pathophysiology of Dengue: A Prospective Observational Study.
Observational study in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05611710 (Anakinra for Dengue Patients With Hyperinflammation - a Randomized Double-blind Placebo-controlled Trial), which is not on this map. Cited by 22 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Anakinra for Dengue Patients With Hyperinflammation - a Randomized Double-blind Placebo-controlled Trial
Who cites it
22 citing papers in PubMed, 3 syntheses or guidelines pooled it, 32 citations in OpenAlex.
- Early biomarkers for prediction of severe manifestations of dengue fever: a systematic review and a meta-analysis.Scientific reports · 2023Pooled it
- Plasma leakage in dengue: a systematic review of prospective observational studies.BMC infectious diseases · 2021Pooled it
- Risk predictors of progression to severe disease during the febrile phase of dengue: a systematic review and meta-analysis.The Lancet. Infectious diseases · 2021Pooled it
- Metabolic and cardiovascular comorbidities as predictors of severe dengue in Vietnamese adults: a retrospective study, 2022-2024.Osong public health and research perspectives · 2026Article
- Dengue and severe dengue.Clinical microbiology reviews · 2025Review
- Persistent Subclinical Inflammation and Long-term Functional and Cognitive Outcomes After Dengue Shock and Septic Shock in Vietnam.Open forum infectious diseases · 2025Article
- Dengue virus infection: how platelet-leukocyte crosstalk shapes thrombotic events and inflammation.Molecular biology reports · 2025Review
- National dengue surveillance, Cambodia 2002-2020.Bulletin of the World Health Organization · 2023Article
- Liver immunopathogenesis in fatal cases of dengue in children: detection of viral antigen, cytokine profile and inflammatory mediators.Frontiers in immunology · 2023Article
- Platelet derived exosomes disrupt endothelial cell monolayer integrity and enhance vascular inflammation in dengue patients.Frontiers in immunology · 2023Article
- The compensatory reserve index predicts recurrent shock in patients with severe dengue.BMC medicine · 2022Observational
- MicroRNA 573 Rescues Endothelial Dysfunction during Dengue Virus Infection under PPARγ Regulation.Journal of virology · 2022Article
- Dengue induces iNOS expression and nitric oxide synthesis in platelets through IL-1R.Frontiers in immunology · 2022Article
- Infection of Endothelial Cells by Dengue Virus Induces ROS Production by Different Sources Affecting Virus Replication, Cellular Activation, Death and Vascular Permeability.Frontiers in immunology · 2022Article
- Peripheral arterial tonometry as a method of measuring reactive hyperaemia correlates with organ dysfunction and prognosis in the critically ill patient: a prospective observational study.Journal of clinical monitoring and computing · 2021Observational
- Article
- Microvascular dysfunction in septic and dengue shock: Pathophysiology and implications for clinical management.Global cardiology science & practice · 2020Review
- Dengue virus induces PCSK9 expression to alter antiviral responses and disease outcomes.The Journal of clinical investigation · 2020Article
- Visual and Biochemical Evidence of Glycocalyx Disruption in Human Dengue Infection, and Association With Plasma Leakage Severity.Frontiers in medicine · 2020Article
- Metformin as adjunctive therapy for dengue in overweight and obese patients: a protocol for an open-label clinical trial (MeDO).Wellcome open research · 2020Article
Corrections and comments
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Authors and funding
16 authors at 5 institutions in 4 countries.
Funding
Abstract
backgroundDengue can cause increased vascular permeability that may lead to hypovolemic shock. Endothelial dysfunction may underlie this; however, the association of endothelial nitric oxide (NO) pathways with disease severity is unknown.
methodsWe performed a prospective observational study in 2 Vietnamese hospitals, assessing patients presenting early (<72 hours of fever) and patients hospitalized with warning signs or severe dengue. The reactive hyperemic index (RHI), which measures endothelium-dependent vasodilation and is a surrogate marker of endothelial function and NO bioavailability, was evaluated using peripheral artery tonometry (EndoPAT), and plasma levels of l-arginine, arginase-1, and asymmetric dimethylarginine were measured at serial time-points. The main outcome of interest was plasma leakage severity.
resultsThree hundred fourteen patients were enrolled; median age of the participants was 21(interquartile range, 13-30) years. No difference was found in the endothelial parameters between dengue and other febrile illness. Considering dengue patients, the RHI was significantly lower for patients with severe plasma leakage compared to those with no leakage (1.46 vs 2.00; P < .001), over acute time-points, apparent already in the early febrile phase (1.29 vs 1.75; P = .012). RHI correlated negatively with arginase-1 and positively with l-arginine (P = .001).
conclusionsEndothelial dysfunction/NO bioavailability is associated with worse plasma leakage, occurs early in dengue illness and correlates with hypoargininemia and high arginase-1 levels.
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