Proteinuria and gall bladder wall thickness as predictive indicators for dengue severity in pediatric patients

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Abstract Objectives Dengue is a mosquito-borne viral illness affecting children and can progress to severe forms with capillary leakage, bleeding and organ dysfunction. Early detection is crucial to reduce complications. This study evaluated the predictive value of 2 noninvasive markers, urine albumin-creatinine ratio (UACR) and gall bladder wall thickness (GBWT) for disease severity in pediatric dengue. Methods A prospective observational study was conducted from May 2023 to November 2024 at a tertiary care hospital in Northern India. Children aged 6 months to 12 years with moderate to severe dengue (WHO 2009 classification) were included. UACR was measured from spot urine samples at admission, during deterioration or at discharge. GBWT was assessed via abdominal ultrasound between days 3 and 6 of fever. Associations with disease severity, laboratory parameters, and mortality outcomes were analyzed. Results Among 74 participants, mean UACR (mg/g) was significantly higher in severe dengue compared to moderate cases (136.31 [151.26] vs. 44.87 [59.77]; P < 0.001), with elevated UACR linked to higher mortality. Mean GBWT (mm) was significantly greater in severe dengue (7.35 [2.25] vs. 5.11 [2.49]; P = 0.035), correlating with poor outcomes. Sensitivity and specificity of UACR (cutoff 30 mg/g) were 62% and 60%, and GBWT at 5 mm were 81% and 60%. Odds ratios for severe dengue were 3.9 (UACR), 10.7 (GBWT) and 13.3 (both). Honeycomb GBWT patterns were more frequent in fatal cases. Conclusion UACR and GBWT, while not definitive alone, are noninvasive adjuncts for predicting severity and mortality in pediatric dengue, supporting early identification, triage and management.

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