Prognostic Indicators for Dengue Infection Severity

Abstract

Background: Symptomatic dengue infection can be classified into 3 patterns based on their severity; dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). In clinical practice, the diagnosis and management are based on clinical findings and abnormal initial laboratory tests. We conducted the present study to explore a set of parameters, preferable routine, or at least easy to investigate, that could be used as indicators for dengue infection severity.

Methods: A retrospective cohort study was conducted in three university-affiliated hospitals, one general hospital and two referral hospitals, in the northern part of Thailand. Patients were grouped into the three severity categories (DF, DHF, and DSS), using modified WHO criteria. Pre-defined prognostic indicators were compared. The prognostic indicators for dengue severity were analyzed by a multivariable polytomous logistic regression and presented with odds ratios.

Results: From 777 patients overall, 391 were classified as DF, 296 with DHF, and 90 with DSS. The characteristics that increased the risk of DHF were; age > 6 year (OR = 1.85), hepatomegaly (OR = 3.49), any bleeding episodes (OR = 1.43), white cell count > 5,000/L (OR = 1.80), and platelet <= 100,000/L (OR = 3.72). The characteristics that increase the risk of DSS were; hepatomegaly (OR = 43.44), any bleeding episodes (OR = 5.58), pulse pressure <= 20 mmHg (OR = 19.09), SBP < 90 mmHg (OR = 2.45), hematocrit > 40% (OR = 1.88), white cell count > 5,000/L (OR = 2.36), and platelet <= 100,000/L (OR = 10.60).

Conclusions: The severity of dengue infection is significantly associated with some routine clinical parameters. These parameters may be used to develop a future scoring system to predict and manage dengue infection severity early in the course of the illness.




doi: http://dx.doi.org/10.4021/ijcp73w