Secondary dengue virus infection is associated with endothelial activation and hypotension in an outpatient cohort from the Philippines
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Bibliographic record
Abstract
Background Secondary dengue virus (DENV) infection is a known risk factor for severe clinical manifestations. Antibody-dependent enhancement of viral pathogenesis explains this phenomenon; however, the underlying mechanisms remain incompletely defined.Objectives To compare the frequency of hypotension, endothelial activation, systemic inflammation, and thrombocytopenia in patients with primary and secondary DENV infection.Methods This was a cross-sectional study among children and young adults aged 1–26 years conducted at an outpatient clinic in the Philippines. Secondary infection was defined by the presence of detectable anti-DENV IgG antibodies at presentation. Clinical data and haematologic parameters were recorded. Plasma concentration of circulating markers of endothelial activation and inflammation were quantified by Luminex® assay.Results Among 244 patients (median age 9 years, 40% female), 93 (38%) were IgG positive. Secondary infection was associated with a 2.2-fold increased odds (95% CI, 1.1–4.1) of hypotension compared to primary infection. Endothelial activation, quantified using a composite index of six endothelial markers (Ang1, Ang2, sTie2, sFlt1, sICAM1, and sEndoglin), was significantly higher in secondary infection (p < 0.001). Platelet counts were lower in secondary infection (170 × 109/L vs 230 × 109/L, p < 0.0001). IL-10 levels were elevated in secondary infection (76 pg/mL vs 33 pg/mL, p < 0.001). Systemic inflammation, quantified using a composite index of four plasma markers (TNF, CXCL8/IL-8, CXCL10/IP-10, PCT), correlated with endothelial activation (τ = 0.39, p < 0.001) and IL-10 (τ = 0.32, p < 0.0001).Conclusion Endothelial activation, IL-10-mediated immune dysregulation, and platelet depletion are associated with transient vascular hyperpermeability in secondary DENV infection.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it