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Open a cess: www.balimedicaljournal.org and ojs.unud.ac.id/index.php/bmj The role of macrophage Migration Inhibitory Factor (MIF) in pediatric dengue infection at Sanglah Hospital, Bali, Indonesia I Made Gede Dwi Lingga Utama1*, Ni Made Ayu Agustini2 Background:  Macrophage migration inhibitory factor (MIF) is known had pleiotropic properties particularly participating in inflammatory and immune responses. MIF has initially involved phagocytosis, spreading, and tumoricidal activity in macrophage. Recently, MIF was determined as a proinflammatory cytokine that has a pivotal role in viral infection such as dengue. This study aims to evaluate the role of MIF levels in patients with dengue infection at Sanglah General Hospital, Bali, Indonesia Methods:  A cross-sectional study was conducted among 48 children aged 1 to 12 years who hospitalized in the Children's Ward of Sanglah General Hospital, Bali, Indonesia, from August 2016 to July 2017. The respondents were divided into two groups: 24 children with a diagnosis of Dengue Shock Syndrome (DSS) (Group 1) and 24 non-DSS children. Data regarding age group, gender, obesity status, history of secondary infection, grading for dengue infection, and levels of MIF were assessed in this study. The MIF levels between both groups were evaluated and analyzed using SPSS version 23 for Mac. Results:  Most of the patients were age > 5 years old in NonDSS (87.5%) and DSS (54.2%) groups. However, females were predominant in the Non-DSS group (66.7%), but males in the DSS group (58.3%). The non-obesity history was more frequent in both Non-DSS (87.5%) and DSS (87.5%) groups. But, the history of secondary infection was more common in the DSS (70.8%) compared with a non-DSS group (37.5%). A significant difference in mean MIF levels was found between patients with DSS (102 (42.91-141.12) ng/ml) and non-DSS (24.85 (12.61-50.80) ng/ml) (p <0.001). MIF levels were significantly different between several degrees of dengue infection (P<0.05). Conclusions: Serum MIF levels in non-DSS patients significantly differ from MIF levels in DSS patients. MIF serum levels increase in accordance with the increasing degree of severity of dengue infection. This data shows that MIF has a role in the occurrence of severe dengue infection.