Serum Cortisol and Lipid Profile as Predictors of Dengue Severity in Children: A Prospective Observational Study

Introduction: Early prediction of severe dengue in children continues to be difficult, even with World Health Organisation (WHO) warning signs. Alterations in stress hormones and lipid metabolism have been associated with dengue severity; however, prospective paediatric data are limited. Serum cortisol and lipid profile are routinely available laboratory parameters and may provide additional information regarding disease severity. Aim: To evaluate the significance of serum cortisol and lipid profile in forecasting the advancement to severe dengue in children. Materials and Methods: This prospective observational study was conducted in the Department of Paediatrics, SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, Tamil Nadu, India, over two years (July 2024-July 2026). A total of 90 dengue NS1 or IgM ELISA-positive children aged between 0-14 years with warning signs and presenting between days 3 and 7 of illness were enrolled after informed consent. Serum cortisol and fasting lipid profile were measured at enrolment, and the day of illness at sampling was recorded. Children were classified according to subsequent progression to severe dengue. Categorical variables were compared using the Chisquare test and continuous variables using the independentsamples t-test; p-value <0.05 was considered statistically significant. Results: In the present study, 15 out of 90 (16.67%) children progressed to severe dengue. Boys constituted 57/90 (63.33%) of the cohort, and the largest age group was 1-5 years (32/90; 35.56%). Fluid accumulation, mucosal bleeding, lethargy, and significant liver enlargement were significantly associated with progression to severe dengue. Severe dengue was also associated with higher total leucocyte count and serum urea, lower serum sodium and bicarbonate, and prolonged prothrombin time. Mean serum cortisol was higher in children who progressed to severe dengue than in those who did not (18.74±6.14 vs 15.46±4.48 μg/dL; p-value =0.017). Mean triglyceride levels were also higher (220.07±141.71 vs 162.97±62.69 mg/dL; p-value =0.014), whereas mean total cholesterol levels were lower (99.67±23.70 vs 122.01±26.71 mg/dL; p-value =0.003). Very Low-Density Lipoprotein (VLDL), Low-Density Lipoprotein Cholesterol (LDL-C), and High-Density Lipoprotein (HDL) levels did not differ significantly between groups. Conclusion: High levels of cortisol and triglycerides with low levels of total cholesterol at the time of admission are strongly linked to the development of severe dengue.