URINE SPOT PROTEIN-CREATININE RATIO AS A PREDICTOR OF DISEASE SEVERITY AND ADVERSE OUTCOMES IN CHILDREN WITH DENGUE: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background:
Early identification of severe dengue in children remains a clinical challenge. The spot urine protein-creatinine ratio (UPCR) is a non-invasive biomarker that reflects glomerular permeability and may serve as an early indicator of capillary leakage in dengue.

Objectives:
To evaluate the association between spot UPCR and disease severity and to determine its predictive value for adverse clinical outcomes in pediatric dengue.

Methods:
This prospective observational study enrolled 120 children (1 month to 18 years) with serologically confirmed dengue admitted to a tertiary care hospital during the 2023 dengue epidemic season. UPCR was measured within 24 hours of admission. Disease severity was classified per WHO 2009 criteria. Clinical outcomes assessed included ICU admission, prolonged hospitalization, and hypotension requiring intravenous fluids. Statistical analyses included correlation testing, ROC curve analysis, and binary logistic regression.

Results:
Children with severe dengue had significantly higher mean UPCR values (1.02 ± 0.34 mg/mg) than those with mild disease (0.45 ± 0.12 mg/mg; p<0.001). A UPCR threshold of ≥0.75 mg/mg predicted severe dengue with 86.7% sensitivity and 78.3% specificity (AUC: 0.89; 95% CI: 0.83–0.94). Elevated UPCR was also associated with higher rates of ICU admission (38.2% vs 9.2%), prolonged hospitalization (58.2% vs 21.5%), and hypotension (47.3% vs 12.3%) (p<0.001 for all). UPCR positively correlated with hematocrit (r=+0.41) and negatively with platelet count (r=–0.38) and serum albumin (r=–0.43).

Conclusion:
Spot UPCR is a reliable, early predictor of severe dengue and adverse outcomes in children. Its low-cost, non-invasive nature makes it particularly useful for triaging high-risk patients in resource-limited settings. Larger multicenter studies are recommended to validate its use in routine clinical practice.