ORIGINAL ARTICLE Bali Medical Journal (Bali Med J) 2017, Volume 5, Number 3: 562-567 P-ISSN.2089-1180, E-ISSN.2302-2914 562 Open access: www.balimedicaljournal.org and ojs.unud.ac.id/index.php/bmj CrossMark Published by DiscoverSys ABSTRACT Backgrounds: Dengue virus infection (DVI) consists of mild-to-severe manifestations. The increasing hematocrit of 20% is used for detecting leakage of plasma, but it is a single parameter that is easily influenced by certain factors. It is necessary to examine the ratio of albumin/ globulin which is more stable. The purpose of this study is to find out the ratio of albumin/globulin against various degrees of DVI. Methods: This is an analytic observational study with a cross- sectional and prospective cohort. The study was conducted at the Prof. Dr. R.D. Kandou Hospital, Pancaran Kasih Hospital, and R.W. Monginsidi Hospital from March 2013 to October 2014. The sample is obtained from at least 38 children for each group of DVI. Data were analyzed using SPSS 15, with significant value at p ≤ 0.05. Results: There were 164 children with DVI during the study, but we analyzed only 39 patients with DF, 39 patients with DHF, and 41 patients with DSS. All patients with DF had a albumin/globulin ratio ≥ 1.2, whereas 4 DHF patients and 5 DSS patients had a albumin/ globulin ratio ≥ 1,2. Conclusions: There were significant differences in the ratio of albumin/globulin between DF, DHF, and DSS groups. It is emphasized that in the evaluation of plasma leakage using the ratio of albumin/ globulin the changing levels of albumin should be considered. We should keep in mind also that there are other factors that can affect the synthesis of albumin. Keywords: Ratio of albumin/globulin, Dengue virus infection, DF, DHF, DSS Cite This Article: Rampengan, N.H., Daud, D., Warouw, S., Ganda, I.J. 2017. Albumin globulin ratio in children with dengue virus infection at Prof. Dr. R. D. Kandou Hospital, Manado Indonesia. Bali Medical Journal 5(3): 562-567. DOI:10.15562/bmj.v5i3.569 INTRODUCTION Dengue virus infection (DVI), notably dengue hemorrhagic fever (DHF), is still a health threat in the world because it is a cause of serious morbid- ity and mortality, particularly in tropical and subtropical regions, including Indonesia. 1,2 Each year an estimated 50 million cases of DVI with 500,000 cases of dengue and at least 24,000 cases were reported dead. 3,4 In Asia, DHF/dengue shock syndrome (DSS) is currently the main cause of patients admitted to hospital, with a high mortality rate ranging from 0.5 to 5%. 5,6 In Indonesia, the incidence of DHF has increased prominently from 37.11 0 / 00 in 2004 to 60.06 0 / 00 in 2008. 7 Dengue virus infection can cause a spec- trum of clinical manifestations, varying from self-limited fever, namely dengue fever (DF), to the severe form, DHF, and can lead to shock or death. 3 Teoretically, DF is a relatively mild disease whereas DHF is a disease that can be life-threatening if it is not detected or addressed adequately. 8 Te increasing of vascular permeabil- ity and vasculopathy is a sign of DHF and DSS and what distinguishes it from DF. 9 Te state of plasma leakage that occurs in DHF with shock within no more than 48 hours and generally afer 48 hours will be followed by immediate and spontaneous improvement. 10 Based on the protocol of the World Health Organization (WHO) in 1997, DHF can be distin- guished from the DF base on increasing hematocrit, pleural efusion, or ascites. 8 Other way to detect the leakage of plasma is by chest X-ray, ultrasound, and hypoalbuminemia. Te leakage of plasma can happen when albumin levels ≤ 3.5 g% or there are changes in albumin level of 0.5 g%. 11 Nevertheles, all the means mentioned above is a single parameter that can be infuenced by certain factors, such as hematocrit values found normal in DVI patients with anemia, bleeding, and fuid therapy; therefore, there is a need to have more stable parameters that can be assessed using the ratio of albumin/globulin. 12 A study using the ratio of albumin/globulin was conducted on patients with systemic infammatory response syndrome (SIRS) and on patients who sufered from burns and sepsis. Te normal value of the ratio of albumin/globulin is 1.2–1.5. 13,14 A research on the assessment of ratio of albumin/globulin conducted on people with burns were associated with severity of disease, but the research on the DVI has never been reported. Besides, it has huge clinical signifcance in the early detection of plasma leakage in DVI. 13,14 1 Department of Child Health, Medical School, Sam Ratulangi University, Manado, Indonesia 2 Department of Child Health, Medical School, Hasanuddin University, Makassar, Indonesia * Correspondence/Reprint request to: Novie Homenta Rampengan, Department of Child Health, Medical School, Sam Ratulangi University, Prof. Dr. R.D. Kandou General Hospital, Jl Raya Tanawangko, Manado 95263, Indonesia. novierampengan@yahoo.com, novierampengan@hotmail.com Received: 30 October 2016 Accepted: 11 December 2016 Published: 29 December 2016 Albumin globulin ratio in children with dengue virus infection at Prof. Dr. R. D. Kandou Hospital, Manado Indonesia Novie Homenta Rampengan, 1* Dasril Daud, 2 Sarah Warouw, 1 Idham Jaya Ganda 2