Association Between Soluble Notch Ligand Delta-like Ligand 1 and Bleeding Complications in Patients With Dengue Fever Infection

Bleeding associated with endothelial damage is one key feature of severe dengue fever. Here, we investigated whether Notch ligands are associated with bleeding in 115 patients with confirmed dengue infection in Vietnam. Soluble Notch ligands were determined by ELISA. 14.8% (17/115) experienced bleeding manifestations. High soluble DLL1 (sDLL1) plasma levels was associated with bleeding (median 15674 pg/ml vs 7117 pg/ml; p<0.001). ROC analysis demonstrated that sDLL1 had the best test performance (AUC=0.852), with 88% sensitivity and 84% specificity. The combination with ALT/AST slightly increased DLL1 performance. sDLL1 may be useful to guide clinical management of dengue patients in endemic settings.