Table 1.
Patient characteristics and baseline data for children with dengue hemorrhagic fever/dengue shock syndrome.
Figure 1.
Plasma levels of Weibel-Palade body constituents in Indonesian children with dengue.
(A) VWF antigen, (B) VWF propeptide and (C) osteoprotegerin levels (all determined by ELISA) in Indonesian children with dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) and in healthy controls. Horizontal lines represent median values. The upper limit of detection of the OPG assay was 1200 pg/ml; 49% and 70% of children in the DHF and DSS group, respectively, had an OPG plasma level above this cut-off value at enrollment. No plasma available for analysis in two patients from the DHF group and one from the DSS group at day 1 and in fifteen and six patients from the DHF and DSS group at discharge. P values were determined by Wilcoxon matched-pairs signed rank test for data in time and Mann Whitney U- test for comparison with the control group. *p value<0.05, **p value<0.01.
Figure 2.
Plasma ADAMTS-13 activity level and VWF activation factor in Indonesian children with dengue.
(A) ADAMTS-13 activity level in children with dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) and in healthy controls. The ADAMTS-13 activity levels were determined by FRETS-VWF73 assay and are depicted in % of normal pool plasma. (B) VWF activation factors were determined by ELISA using the llama-derived nanobody AU/VWFa-11. The VWF activation factor represents the relative amount of VWF that circulates in an active platelet-binding conformation, whereby the VWF activation factor of normal pooled plasma was referred to as 1. Horizontal lines represent median values. No plasma available for analysis in two patients from the DHF group and one from the DSS group at day 1 and in fifteen and six patients from the DHF and DSS group at discharge. P values were determined by Wilcoxon matched-pairs signed rank test for data in time and Mann Whitney U-test for comparison with the control group. *p value<0.05, **p value<0.01.
Figure 3.
VWF multimer pattern in Indonesian children with dengue.
Plasma VWF multimer distribution was analysed by agarose gel electrophoresis, followed by in-gel immunostaining. Electrophoresis was performed from the top to the bottom. Plasma at discharge (Dis) from 3 children with severe dengue (patient 1–3) demonstrated a reduction in large and intermediate VWF multimers compared to plasma at enrollment (D0) or day 1 (D1), consistent with an acquired von Willebrand disease. No ultralarge VWF multimers were seen. NPP depicts normal pool plasma. VWF:Ag, VWF antigen. * The last available platelet count before discharge is given.
Table 2.
Spearman correlation (r) of VWF-related variables with laboratory and clinical parameters of dengue severity.