{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T07:05:06Z","timestamp":1779433506405,"version":"3.53.1"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Hyperferritinemia has been described as a potential marker of disease severity in various conditions, including dengue infection, where it has been associated with worse clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the utility of serum ferritin levels in discriminating dengue with warning signs or severe dengue.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This single-center prospective cohort study evaluated ferritin levels in relation to disease severity in patients aged 1 month to 17 years. Patients were classified into two groups: non-severe dengue (group 1, without warning signs) and dengue with warning signs or severe dengue (group 2). All cases were laboratory-confirmed by antigen detection or serology and were evaluated in the Pediatric Emergency Department between December 2023 and May 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 142 patients were included, of whom 42.2% were classified as group 1 and 57.8% as group 2. Median ferritin levels were significantly higher in group 2 compared with group 1 [841.5\u2005ng\/mL (IQR: 244\u20131,747) vs. 261.5\u2005ng\/mL (IQR: 130\u2013645.5);\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001]. A ferritin cutoff value of 382\u2005ng\/mL was associated with dengue with warning signs or severe dengue (39% vs. 14%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001; RR: 4.0; 95% CI: 2.0\u20138.2). The area under the receiver operating characteristic (ROC) curve was 0.67 (95% CI: 0.57\u20130.75), with a sensitivity and specificity of 67%, a positive predictive value of 60%, and a negative predictive value of 73%. The positive and negative likelihood ratios were 2.0 and 0.49, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Higher ferritin levels were observed in patients with dengue with warning signs or severe dengue. Although a cutoff value of \u2265382\u2005ng\/mL was associated with this composite outcome, its discriminatory performance was limited. Ferritin may serve as an adjunctive biomarker but should not be used as a standalone predictor of disease severity in pediatric dengue.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1798539","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T06:08:43Z","timestamp":1779430123000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Serum ferritin as an adjunctive marker of dengue severity in the pediatric emergency department"],"prefix":"10.3389","volume":"14","author":[{"given":"Ricardo","family":"Iramain","sequence":"first","affiliation":[{"name":"Pediatric Emergency Department, Faculty of Medical Sciences, Universidad Nacional de Asunci\u00f3n","place":["San Lorenzo, Paraguay"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo","family":"Jara","sequence":"additional","affiliation":[{"name":"Pediatric Emergency Department, Faculty of Medical Sciences, Universidad Nacional de Asunci\u00f3n","place":["San Lorenzo, Paraguay"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Ortiz","sequence":"additional","affiliation":[{"name":"Pediatric Emergency Department, Faculty of Medical Sciences, Universidad Nacional de Asunci\u00f3n","place":["San Lorenzo, Paraguay"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Cardozo","sequence":"additional","affiliation":[{"name":"Pediatric Emergency Department, Faculty of Medical Sciences, Universidad Nacional de Asunci\u00f3n","place":["San Lorenzo, Paraguay"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roc\u00edo","family":"Mor\u00ednigo","sequence":"additional","affiliation":[{"name":"Pediatric Emergency Department, Faculty of Medical Sciences, Universidad Nacional de Asunci\u00f3n","place":["San Lorenzo, Paraguay"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc\u00eda","family":"Franco","sequence":"additional","affiliation":[{"name":"Pediatric Emergency Department, Faculty of Medical Sciences, Universidad Nacional de Asunci\u00f3n","place":["San Lorenzo, Paraguay"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1097\/MOP.0000000000001220","article-title":"Changing epidemiology of dengue fever in children in South America","volume":"35","author":"Fonseca","year":"2023","journal-title":"Curr Opin Pediatr"},{"key":"B2","year":"2022"},{"key":"B3","year":"2023"},{"key":"B4","year":"2023"},{"key":"B5","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1007\/s12098-022-04394-8","article-title":"Management of dengue: an updated review","volume":"90","author":"Tayal","year":"2023","journal-title":"Indian J 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