Background. Dengue is endemic in most parts of the tropics with a significant mortality of 1–5%. Although individual case reports and case series have been published, large-scale case controls studies are few. The objective of this study was to find clinical and laboratory predictors of mortality in dengue. Methods. Hospital case record based case control study was performed. Results. Twenty fatalities with 80 controls were analyzed. Clinical parameters of postural dizziness (OR 3.2; 95% CI 1.1–8.9), bleeding (OR 31.9; 95% CI 6.08–167.34), presence of plasma leakage (OR 64.6; 95% CI 7.45–560.5), abdominal tenderness (OR 2.24; 95% CI 0.79–6.38), and signs of cardiorespiratory instability at admission increased the risk of dying from dengue. Altered consciousness was exclusively seen in 20% of cases. Laboratory parameters of elevated CRP (OR 1.652; 95% CI 1.28–2.14), AST, or ALT > 500 IU/L (OR 52.5; 95% CI 12.52–220.1) and acute kidney injury (AKI) (OR 103.5; 95% CI 13.26–807.78) during hospital stay increased the odds of dying. Need for assisted ventilation and multiorgan dysfunction (MOD) were exclusively seen in the cases. Multivariate logistic regression revealed bleeding at admission, AKI, and elevated hepatic transaminase >500 IU/L to be independent predictors of mortality. Conclusions. This case control study revealed that mortality from dengue could be predicted using clinical parameters at admission and low cost routine laboratory investigations.

Background Dengue is endemic in most parts of the tropics with a significant mortality of 1-5%. Although individual case reports and case series have been published, large-scale case controls studies are few. The objective of this study was to find clinical and laboratory predictors of mortality in dengue. Methods Hospital case record based case control study was performed. Results Twenty fatalities with 80 controls were analyzed. Clinical parameters of postural dizziness (OR 3.2; 95% CI 1.1 - 8.9), bleeding (OR 31.9; 95% CI 6.08 - 167.34), presence of plasma leakage (OR 64.6; 95% CI 7.45 – 560.5), abdominal tenderness (OR 2.24; 95% CI 0.79 – 6.38) and signs of cardio-respiratory instability at admission increased the risk of dying from dengue. Altered consciousness was exclusively seen in 20% of cases. Laboratory parameters of elevated CRP (OR 1.652; 95% CI 1.28 – 2.14), AST or ALT> 500IU/L (OR 52.5; 95% CI 12.52 – 220.1) and acute kidney injury (AKI) (OR 103.5; 95% CI 13.26 – 807.78) during hospital stay increased the odds of dying. Need for assisted ventilation and multi organ dysfunction (MOD) were exclusively seen in the cases. Multivariate logistic regression revealed bleeding at admission, AKI and elevated hepatic transaminase >500IU/L to be independent predictors of mortality. Conclusions This case-control study revealed that mortality from dengue could be predicted using clinical parameters at admission and low cost routine laboratory investigations.

Background: Dengue is one of the most important mosquito-borne viral infections to affect humans. It is most often a self-limiting febrile illness but in some instances can progress to plasma leakage and in extreme cases culminate in death. Dengue is endemic in Sri Lanka and 2017 saw the largest outbreak on record with over 160,000 cases and over 300 deaths. Health care services reached its’ limits coping with this epidemic. The objective of this study was to identify reliable, low-cost, easily-accessible and objective predictors of Dengue hemorrhagic fever (DHF) that can be used as a triage tool in epidemic situations. Methodology/Principal findings: Serologically confirmed 350 serial adult dengue patients were included in the study. 257 (73.4%) were classified as dengue fever (DF, non leakers) and 93 (26.5%) as DHF with plasma leakage. Bedside ultrasonography was used to identify plasma leakage. Bivariate and regression analysis showed platelet count (Pearson r 0.59), and AST (r 0.27) to be significantly correlated with plasma leakage and platelet count to have a moderate predictive association (R2 0.35) with plasma leakage. Platelet count <50,000/mm3 (OR 23.7; 95% CI 12.2-45.9), AST> twice, upper limit of normal (OR 7.5; 95% CI 3.9-14.3) and ALT> twice, upper limit of normal (OR 2.4; 95%CI 1.4-3.6) increased the likelihood of DHF. In the final analysis, logistic regression identified platelet count <50,000/mm3 (OR 17.2; 95% CI 8.6-34.1) and AST>2ULN (OR 5.1, 95% CI 2.1-12.1) at time of plasma leakage as significant independent predictors of DHF. ROC curve performed for Platelet count had an AUC of .89 and at a platelet count of 50,000/mm3 predicted DHF with a sensitivity of 87% and specificity of 79%. AUC for AST was 0.72 and at 93Iu/L predicted DHF with a sensitivity of 85% and specificity of 60%. Conclusion: We have identified 2 laboratory parameters that could be used to identify plasma leakage and might be useful to stratify dengue-infected patients at risk for developing severe dengue.

Background: Dengue is one of the most important mosquito-borne viral infections to affect humans. It is most often a self-limiting febrile illness but in some instances can progress to plasma leakage and in extreme cases culminate in death. The objective of this study was to identify reliable, low-cost, easily-accessible and objective predictors of Dengue hemorrhagic fever (DHF) that can be used as a triage tool in epidemic situations. Methods A cohort of dengue fever patients were selected and data on symptoms, clinical signs, routine lab tests, ultrasonography and packed cell volume measurements collected. The demographics and clinical characteristics of severe and non-severe dengue cases were described Bivariate and regression analysis were used to identify variables significantly correlated with plasma leak. Results Serologically confirmed 350 serial adult dengue patients were included in the study. 257 (73.4%) were classified as dengue fever (DF, non leakers) and 93 (26.5%) as DHF with plasma leakage. Bivariate and regression analysis showed platelet count (Pearson r 0.59), and AST (r 0.27) to be significantly correlated with plasma leakage and platelet count to have a moderate predictive association ( R 2 0.35) with plasma leakage. Platelet count <50,000/mm 3 (OR 23.7; 95% CI 12.2-45.9), AST> twice, upper limit of normal (OR 7.5; 95% CI 3.9-14.3) and ALT> twice, upper limit of normal (OR 2.4; 95%CI 1.4-3.6) increased the likelihood of DHF.In the final analysis, logistic regression identified platelet count <50,000/mm 3 (OR 17.2; 95% CI 8.6-34.1) and AST>2ULN (OR 5.1, 95% CI 2.1-12.1) at time of plasma leakage as significant independent predictors of DHF.ROC curve performed for Platelet count had an AUC of .89 and at a platelet count of 50,000/mm 3 predicted DHF with a sensitivity of 87% and specificity of 79%. AUC for AST was 0.72 and at 93Iu/L predicted DHF with a sensitivity of 85% and specificity of 60%. Conclusion: We have identified 2 laboratory parameters that could be used to identify plasma leakage and might be useful to stratify dengue-infected patients at risk for developing dengue hemorrhagic fever Background Dengue fever is endemic in Sri Lanka and a major public health problem. The first serological confirmation of Dengue in Sri Lanka was done in 1962(1) and the first outbreak was recorded in 1965(2).