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Dengue shock syndrome is a severe complication of dengue hemorrhagic fever (DHF), characterized by a massive increase in vascular permeability. Plasma cytokine concentrations were prospectively studied in 443 Vietnamese children with DHF, of whom 6 died. Shock was present in 188 children on admission to hospital, and in 71 children it developed later. Contrary to expectations, certain inflammatory markers (interleukin-6 and soluble intercellular adhesion molecule-1) were lower in the group with shock, and this may reflect the general loss of protein from the circulation due to capillary leakage. Only soluble tumor necrosis factor receptor (TNFR) levels showed a consistent positive relationship with disease severity. In patients with suspected DHF without shock, admission levels of sTNFR-75 in excess of 55 pg/mL predicted the subsequent development of shock, with a relative risk of 5.5 (95% confidence interval, 2.3-13.2). Large-scale release of soluble TNFR may be an early and specific marker of the endothelial changes that cause dengue shock syndrome.

Original publication




Journal article


The Journal of infectious diseases

Publication Date





778 - 782


Wellcome Trust Clinical Research Unit, Centre for Tropical Diseases, Ho Chi Minh City, Viet Nam.


Humans, Syndrome, Shock, Tumor Necrosis Factor-alpha, Receptors, Tumor Necrosis Factor, Antibodies, Viral, Cytokines, Prospective Studies, Child, Child, Preschool, Infant, Vietnam, Female, Male, Severe Dengue