Elevated Serum Levels of Matrix Metalloproteinase-9 (MMP-9) in Severe Dengue Virus Infection at Sanglah Hospital Denpasar, Bali - Indonesia

Background: Dengue virus - infected dendritic cells along with cytokines overproduction trigger endothelial barrier dysfunction and plasma leakage through matrix metalloproteinase (MMP)-9 overproduction. The event is responsible for more severe dengue virus infection’s manifestation. The study objective is to measure the association of MMP-9 serum level with disease severity of dengue virus infection. Method: Prospective study of 70 participants hospitalized in Internal Medicine ward of Sanglah Hospital Denpasar, during 1 July 2011 – 31 December 2011 and diagnosed as dengue virus infection were followed during their hospital stay. Baseline demographic were obtained on admission; serum level of MMP-9 was measured once at third –fifth day from fever onset. Independent-samples t-test was used to compare the MMP 9 levels among diagnosis groups and exploration ofvariables were using logistic regression analysis. Result: There was significant higher level of MMP-9 serum level on DHF (median [range]) compared to DF (367.78 ng/mL [81.16 – 797.79] vs.128.67 ng/mL [41.79 – 327.32]; p< 0.0001). After adjusted with baseline hematocrit, for every 10 ng/mL elevation of MMP-9 serum contributes to 1.159 increased risk of DHF with optimal threshold MMP-9 level is 330 ng/mL (100 % sensitivity, 64% specificity). Conclusion: MMP-9 level is associated with dengue severity. The measurement was able to predict the DHF among those infected with dengue virus infection. This may lead to a novel marker of dengue hemorrhagic fever predictor.