Serum fatty acids and progression from dengue fever to dengue haemorrhagic fever/dengue shock syndrome

Polyunsaturated fatty acids (PUFA) might modulate inflammatory responses involved in the development of severe dengue. We aimed to examine whether serum PUFA concentrations in patients diagnosed with dengue fever (DF) were related to the risk of progression to dengue hemorrhagic fever / dengue shock syndrome (DHF/DSS). A secondary aim was to assess correlations between fatty acids (FA) and inflammatory biomarkers in DF patients. We conducted a prospective case-control study nested within a cohort of DF patients who were followed during the acute episode. We compared the distribution of individual FA % of total FA concentration at onset of fever between 109 cases who progressed to DHF/DSS and 235 DF non progressing controls using unconditional logistic regression. We estimated correlations between baseline FA and cytokine concentrations, and compared FA concentrations between the acute episode and >1 y post-convalescence in a subgroup. Docosahexaenoic acid (DHA) was positively related to progression to DHF/DSS (multivariable adjusted odds ratio [AOR] for DHA in quintile 5 vs. 1 = 5.34, 95% confidence interval [CI]: 2.03, 14.1; P, trend = 0.007). Dihomo-γ-linolenic acid (DGLA) was inversely associated with progression (AOR for quintile 5 vs. 1 = 0.30, 95% CI: 0.13, 0.69; P, trend = 0.007). Pentadecanoic acid concentrations were inversely related to DHF/DSS. Correlations of PUFA with cytokines at baseline were low. PUFA were lower during the acute episode than in a disease-free period. In conclusion, serum DHA in DF patients predicts higher odds of progression to DHF/DSS whereas DGLA and pentadecanoic acid predict lower odds.