Early intervention of 5% albumin shown superior control of vascular integrity and function compared to ringer's lactatein hospitalized adult with grade I & II Dengue hemorrhagic fever: a multicenter randomized controlled trial in Indonesia.

IF 2.4 Q3 INFECTIOUS DISEASES Tropical Diseases, Travel Medicine and Vaccines Pub Date : 2024-10-01 DOI:10.1186/s40794-024-00230-3
Rika Bur, Suhendro Suwarto, Herdiman Theodorus Pohan, Joedo Prihartono, Alida Roswita Harahap, Beti Ernawati Dewi, Mohamad Sadikin, Andhika Rachman, Hadi Yusuf
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Abstract

Background: Dengue virus remains a major public health problem with one of the hallmark pathologies is the vascular leakage caused by endothelial dysfunction which can lead to Dengue Hemorrhagic Fever (DHF) manifestation. In the status quo, no specific therapy has been discovered but rather heavily relies on judicious and frequent monitoring of intravenous fluids administration. The current guideline has discussed the roles of fluid therapy during the Dengue Shock Syndrome (DSS) stage, however, administration of early fluid intervention for DHF grade I and II remains uncharted territory. In addition, the choice and timing of colloid administration remains underexplored. As one of the widely available colloids, 5% albumin has known physiological properties that potentially minimize plasma leakage. Therefore, this study aimed to evaluate the benefit of early intervention of 5% albumin in adults with DHF in the hope of preventing the lethal progression to DSS and further, shorten the length of stay (LOS) for patients.

Methods: We conducted a multicenter, open-labeled, randomized controlled trial in Jakarta and Banten to compare the effect of early intervention with 5% albumin in adult patients with DHF compared to Ringer's Lactate (RL). Statistical analyses were conducted using unpaired t-test and Mann-Whitney for normally and abnormally distributed data respectively.

Results: Adult patients with a diagnosis of DHF grade I and II that being hospitalized to receive the early intervention of 5% albumin had significantly lower levels of hemoconcentration 4, 12, and 24 h (p = 0.002, 0.001, 0.003, respectively), higher platelet counts 4 h (p = 0.036), higher serum albumin levels 48 h (p = 0.036), lower proteinuria 24 and 48 h post-albumin administration (p < 0.001, < 0.001, respectively), and shorter LOS (p < 0.001) when compared to the RL group.

Conclusion: Early intervention of 5% albumin showed better control on vascular integrity and function compared to ringer lactate in hospitalized adults with grade I & II DHF, thus halting the progression of DHF into DSS and other related complications which leads to faster recovery and shorter length of stay.

Trial registration: The study was registered to www.

Clinicaltrial: gov with trial registration number NCT04076254, and registration date October 31st 2016.

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印度尼西亚一项多中心随机对照试验显示,与林格乳酸盐相比,5%白蛋白的早期干预能更好地控制血管完整性和功能。
背景:登革热病毒仍然是一个重大的公共卫生问题,其标志性病理之一是由内皮功能障碍引起的血管渗漏,可导致登革出血热(DHF)表现。目前,尚未发现特效疗法,而是严重依赖于对静脉输液进行明智而频繁的监测。现行指南讨论了在登革休克综合征(DSS)阶段进行输液治疗的作用,但对 I 级和 II 级 DHF 进行早期输液干预仍是未知领域。此外,胶体的选择和给药时机仍未得到充分探讨。作为广泛使用的胶体之一,5% 白蛋白具有已知的生理特性,可最大限度地减少血浆渗漏。因此,本研究旨在评估 5%白蛋白早期干预 DHF 成人患者的益处,希望能预防 DSS 的致命进展,并进一步缩短患者的住院时间(LOS):我们在雅加达和万丹开展了一项多中心、开放标签、随机对照试验,以比较在成人 DHF 患者中使用 5%白蛋白与林格乳酸盐(RL)进行早期干预的效果。对正态分布和异常分布的数据分别采用非配对 t 检验和 Mann-Whitney 进行统计分析:结果:确诊为 I 级和 II 级 DHF 的成人患者住院接受 5%白蛋白早期干预后,4、12 和 24 小时的血液浓缩水平明显降低(p = 0.002、0.001、0.003,分别为 0.002、0.001、0.003),4 小时的血小板计数升高(p = 0.036),48 小时的血清白蛋白水平升高(p = 0.036),白蛋白用药后 24 和 48 小时的蛋白尿水平降低(p 结论:5%白蛋白早期干预对 DHF 的治疗效果显著:与林格乳酸盐相比,5%白蛋白的早期干预能更好地控制 I 级和 II 级 DHF 住院成人的血管完整性和功能,从而阻止 DHF 演变为 DSS 及其他相关并发症,使患者更快康复并缩短住院时间:该研究已在 www.Clinicaltrial: gov 注册,试验注册号为 NCT04076254,注册日期为 2016 年 10 月 31 日。
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来源期刊
CiteScore
5.20
自引率
0.00%
发文量
25
审稿时长
17 weeks
期刊介绍: Tropical Diseases, Travel Medicine and Vaccines is an open access journal that considers basic, translational and applied research, as well as reviews and commentary, related to the prevention and management of healthcare and diseases in international travelers. Given the changes in demographic trends of travelers globally, as well as the epidemiological transitions which many countries are experiencing, the journal considers non-infectious problems including chronic disease among target populations of interest as well as infectious diseases.
期刊最新文献
Exploring plant-based dengue therapeutics: from laboratory to clinic. The role of antibody-dependent enhancement in dengue vaccination. Secreted protein NFA47630 from Nocardia farcinica IFM10152 induces immunoprotective effects in mice. Early intervention of 5% albumin shown superior control of vascular integrity and function compared to ringer's lactatein hospitalized adult with grade I & II Dengue hemorrhagic fever: a multicenter randomized controlled trial in Indonesia. A post-marketing study to evaluate the safety and immunogenicity of a quadrivalent influenza split-virion vaccine in elderly people aged 60 years and older.
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