Kerala study finds blood markers that predict severe dengue with near-perfect accuracy
A new study led by the Institute of Advanced Virology (IAV) in Thiruvananthapuram has identified a set of blood biomarkers that can predict which dengue patients will develop severe complications, potentially allowing doctors to allocate hospital resources more efficiently during outbreaks.
Dengue is a challenging tropical disease because it can suddenly worsen when a patient appears to be recovering. Currently, clinicians rely on warning signs such as persistent vomiting, abdominal pain, or bleeding, but these appear only after the underlying pathological process has begun. For decades, researchers have searched for measurable biological indicators — biomarkers — that could predict severe dengue early in the infection.
The IAV team, led by scientist Agiesh Kumar B, has completed a pilot study of 150 patients in collaboration with three major medical colleges in Kerala: Believers’ Church Medical College, Pushpagiri Medical College, and Government Medical College, Thiruvananthapuram. They measured a panel of blood proteins at three points: on admission, during the critical phase (when fever breaks), and during recovery.
The results showed that at admission, biomarker levels were similar across mild, moderate, and severe cases. But at the fever-break stage, two markers spiked sharply — and the spike was far larger in patients who later developed severe dengue, including haemorrhagic shock. Using this data along with clinical warning signs, a computer model predicted severe dengue with close to 100% accuracy.
“What we need is a clinically usable, affordable prognostic assay that can be used by clinicians on the bedside so that they can easily identify patients who need to be kept in the hospital and monitored,” said Dr. Agiesh. “In dengue-endemic regions, this will help health systems optimise their resources.”
The study focuses on endothelial markers — proteins released by cells lining blood vessels. Plasma leakage, a hallmark of severe dengue, occurs when these cells lose their integrity. “Targeting endothelial markers released by activated endothelial cells could serve as effective biomarkers,” Dr. Agiesh explained.
Now IAV plans a larger prospective study involving 2,000 patients. Researchers have winnowed down an initial list of 25 biomarkers to a panel of 8–10 for detailed analysis. They are also collaborating with the National University of Singapore to develop a computational model for severity prediction. The ultimate goal is an indigenously developed prognostic assay that can be integrated into a point-of-care device, potentially with support from the Department of Science and Technology.
The study, supported by IAV Director Sreekumar E. and bioinformatician Abhinand C.S., aims to reduce the burden on hospitals in dengue-endemic regions such as Kerala, which sees large seasonal outbreaks. By identifying patients at high risk of severe disease early, doctors can admit and monitor them, while low-risk patients can be managed at home, easing pressure on healthcare systems.
