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Abstract
Background: COVID-19 and dengue infections share some initial clinical symptoms (such as fever and headache), being a diagnostic challenge in periods of double viral circulation. Aim: To evaluate biomarkers such as D-Dimer
(DD) and Ferritin and associate them with clinical course of dengue and COVID-19 patients. Methods: Retrospective cohort study: consecutive adult patients with COVID-19 symptoms at the emergency department (March- June 2020). Dengue and COVID-19 patients were included. DD ng/mL FEU (VIDAS), C-Reactive Protein (CRP-H) mg/L, ferritin mg/dL (Beckman Coulter AU 680), and hematological parameters (DxH 800, Beckman Coulter) were measured. Results: 230 patients were included: 67 with non-severe dengue and 163 with COVID-19, 85 of whom presented mild infection (MI) and 78 evolved to pneumonia. At admission, dengue patients presented higher DD
((median, IQR) 795 (502-1240) vs 301 (191-472)) and higher Ferritin (304 (219-601) vs 104 (58-300)) than COVID-19 patients with MI but similar to COVID-19 patients who developed pneumonia (DD 593 (331-1470) and
Ferritin 290 (140-817)). CRP-H was very high only in the pneumonia group: 16.9 (7.3-49.2). DD and Ferritin were
higher in dengue patients who developed thrombocytopenia (<100x109/L) and/or in those with increased transaminases (alarm signs). DD P/upper normal limit ratio >4 and ferritin >800 mg/dL were associated with dengue alarm signs: OR (95% CI) 5.9 (1.9-30.1) and 12.7 (1.3-121.5), respectively. They were also associated with COVID- 19 evolution to pneumonia OR (95%CI) 5.6 (1.2-26.4) and 14.6 (1.7-122.8) by bivariate logistic regression. Conclusion: Dengue and COVID-19 infections presented increased inflammatory biomarkers, like DD and ferritin, which seem to be associated with the clinical course of these ni fections.
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