Serial Biomarker Monitoring Reveals Progressive Cardiac Injury in Pediatric Dengue Shock Syndrome

BACKGROUND: Dengue shock syndrome (DSS) is a life-threatening complication of dengue infection, marked by plasma leakage and hemodynamic collapse. Cardiac dysfunction contributes to poor outcomes, but its dynamic progression remains unclear. We investigated temporal changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin I (troponin I) levels in pediatric DSS and their associations with clinical outcomes. METHODS: In this longitudinal study, 113 children with DSS were enrolled. NT-proBNP and troponin I were measured at 2 standardized time points: T1 (approximately 6 hours after initial fluid resuscitation) and T2 (12 hours after T1). A third sample at 30 hours after T1 (T3) was obtained in a subset of patients. Mortality was the primary outcome; secondary outcomes included inotropic support, mechanical ventilation and length of stay. RESULTS: Both biomarkers rose significantly from T1 to T2, indicating progressive myocardial stress and injury. At T1, elevated NT-proBNP and troponin I levels were found in 30.1% and 21.2% of patients, respectively, increasing to 73.5% and 42.5% at T2. Elevated biomarker levels were strongly associated with mortality (P < 0.01). NT-proBNP also predicted inotropic requirement and mechanical ventilation, with good discriminative performance at T1 (area under the curve 0.813). Elevated biomarkers further correlated with multiorgan dysfunction and prolonged pediatric intensive care unit stay. CONCLUSIONS: Serial NT-proBNP and troponin I measurements reveal progressive cardiac involvement in pediatric DSS. These biomarkers offer distinct yet complementary insights into disease severity and may assist early risk stratification and guide fluid and hemodynamic management in critical care.