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

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 severity. Results: 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.