Dengue virus causes illnesses with or without warning indicators for severe complications. There are no clear prognostic signs linked to the disease outcomes. Clinical and laboratory parameters among 102 adult including 17 severe dengue (SD), 33 with warning and 52 without warning signs during early and critical phases were analyzed by statistical and machine learning (ML) models. In classical statistics, abnormal ultrasound findings, platelet count, and low lymphocytes were significantly linked with SD during the febrile phase, while low creatinine, high sodium, and elevated AST/ALT during the critical phase. ML models highlighted AST/ALT and lymphocytes as key markers for distinguishing SD from non-severe dengue, aiding clinical decisions. Parameters like liver enzymes, platelet counts and USG findings were linked with SD.USG testing at an earlier phase of dengue and a point-of-care system for the quantification of AST/ALT levels may lead to an early prediction of SD.

Background: Plasma leakage due to endothelial permeability is regarded as a hallmark process in the pathophysiology of severe dengue. In recent years, the importance of ceramide in regulating vascular tone during viral infection and metabolic diseases has gained attention. The present study aimed to evaluate the plasma levels of ceramide and its association with plasma leakage in dengue patients. Methods: The study involved 30 dengue samples involving severe dengue (SD-10), Dengue with Warning sign (DWW-10), Dengue without Warning Sign (DWOW-10), along with other febrile illness (OFI-10) controls. Samples were collected on the day of admission (DOA), day of defervescence (DOD), and day of convalescence (DOC). Total plasma ceramides (d18:1/22:0) were quantified using RP-HPLC. The correlation between ceramides and hematocrit/platelet count was evaluated using Spearman Rho Correlation. All the statistical analyses were performed using SPSS software. Results: During the febrile phase, a significant (P≤0.05) decrease in the levels of ceramides was observed in dengue compared to OFI (control). Towards the defervescences, the ceramides levels were substantially (P ≤ 0.001) elevated in dengue groups compared to baseline. Most importantly, the ceramide levels were found to be higher in SD patients compared to non-severe dengue (DWW & DWOW) and OFI, particularly at the critical phase of infection. We observed a significant negative correlation (r = -0.867, P ≤0.001) between the platelet count and ceramide levels in SD subjects. Notably, a negative correlation was observed between ceramide and hematocrit during the defervescence phase (R = -0.355, P≤0.05) in the AD group. Conclusion: Elevated levels of circulating plasma ceramides during the defervescence phase of severe dengue show an essential role of ceramides in disease pathogenesis, however further studies are required to ascertain it.