A Multicenter Study of Clinical Presentations and Predictive Factors for Severe Manifestation of Dengue in Adults

Temprasertrudee, Saranya; Thanachartwet, Vipa; Desakorn, Varunee; Keatkla, Jiraporn; Chantratita, Wasun; Kiertiburanakul, Sasisopin

doi:10.1093/ofid/ofw172.455

Cited by 5 publications

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“…We observed that the WCC was significantly higher in the DHF patients from day 6-9. Leukopenia defined as total WCC<4,000/mm 3 has been reported in previous studies and has not been a predictor of DHF, in alignment with our findings (16,27). A similar trend in leucopenia followed by rise in the recovery phase of DHF was earlier reported by Kulratne et al as well (27).…”

Section: Discussionsupporting

confidence: 93%

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Platelet count and AST can reliably predict the onset of plasma leakage in dengue, a low-cost triage tool during epidemics

Medagama

Dalugama

Lakmali

et al. 2019

Preprint

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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).

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Section: Discussionsupporting

confidence: 93%

“…Low platelet counts have previously been reported with dengue fever and few studies have reported the behavior of platelet counts during progression to dengue hemorrhagic fever (16,17). Declining platelet count is associated with plasma leakage.…”

mentioning

confidence: 97%

Platelet count and AST can reliably predict the onset of plasma leakage in dengue, a low-cost triage tool during epidemics

Medagama

Dalugama

Lakmali

et al. 2019

Preprint

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“…Several studies have attempted to investigate plasma leakage predictors among dengue patients aged �15 years. However, studies reported on different parameters, including demographic characteristics of older age [8][9][10][11], gender [8,11], ethnicity [11], diabetes mellitus [9,[10][11][12], hypertension [11], delayed hospitalization [9], secondary infection [9], clinical parameters of bleeding [8], abdominal pain [8,10], lethargy [8,9], or cough [8], and laboratory findings of hematocrit (HCT) rising [12][13][14], thrombocytopenia [13,15], abnormal coagulation profile [14], raised liver enzymes [12,13], low serum albumin (ALB) level [13,15], or thickening of the gall bladder wall [9]. Recent studies have added several new parameters, including procalcitonin [16], lactate [16,17], chymase [18], and cytokines [19], as plasma leakage predictors among dengue patients aged �15 years.…”

Section: Introductionmentioning

confidence: 99%

Predictors of plasma leakage among dengue patients in Thailand: A plasma-leak score analysis

et al. 2021

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Delayed plasma leakage recognition could lead to improper fluid administration resulting in dengue shock syndrome, subsequently, multi-organ failure, and death. This prospective observational study was conducted in Bangkok, Thailand, between March 2018 and February 2020 to determine predictors of plasma leakage and develop a plasma leakage predictive score among dengue patients aged ≥15 years. Of 667 confirmed dengue patients, 318 (47.7%) developed plasma leakage, and 349 (52.3%) had no plasma leakage. Multivariate analysis showed three independent factors associated with plasma leakage, including body mass index ≥25.0 kg/m2 (odds ratio [OR] = 1.784; 95% confidence interval [CI] = 1.040–3.057; P = 0.035), platelet count <100,000/mm3 on fever days 3 to 4 (OR = 2.151; 95% CI = 1.269–3.647; P = 0.004), and aspartate aminotransferase or alanine aminotransferase ≥100 U/l on fever days 3 to 4 (OR = 2.189; 95% CI = 1.231–3.891; P = 0.008). Because these three parameters had evidence of equality, each independent factor was weighted to give a score of 1 with a total plasma-leak score of 3. Higher scores were associated with increased plasma leakage occurrence, with ORs of 2.017 (95% CI = 1.052–3.869; P = 0.035) for score 1, 6.158 (95% CI = 2.914–13.015; P <0.001) for score 2, and 6.300 (95% CI = 2.419–16.407; P <0.001) for score 3. The area under the receiver operating characteristics curves for predicting plasma leakage was good (0.677 [95% CI = 0.616–0.739]). Patients with a plasma-leak score ≥1 had high sensitivity (88.8%), and those with a plasma-leak score of 3 had high specificity (93.4%) for plasma leakage occurrence. This simple and easily accessible clinical score might help physicians provide early and timely appropriate clinical dengue management in endemic areas.

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“…Suwarto in Indonesia reported a significant association between AST and plasma leakage while ALT failed to show an association (19). A similar trend of higher AST in DHF patients was also reported in Japan and Brazil previously (16,33). The reason for persistent greater elevation of AST over ALT in complicated dengue is thought to be due to concomitant release of AST from damage caused to myocytes although this needs to be verified by future research (34).…”

Section: Ralapanawa Et Al Utilized Similar Methods Utilizing the Acutmentioning

confidence: 66%

“…Low platelet counts have previously been reported with dengue fever and few studies have reported the behavior of platelet counts during progression to severe forms of dengue (16,17). Declining platelet count is associated with plasma leakage.…”

Section: Introductionmentioning

confidence: 97%

Platelet count and AST can reliably predict the onset of plasma leakage in dengue, a low-cost triage tool during epidemics

Medagama

Dalugama

Meiyalakan

et al. 2019

Preprint

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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.

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A Multicenter Study of Clinical Presentations and Predictive Factors for Severe Manifestation of Dengue in Adults

Cited by 5 publications

References 0 publications

Platelet count and AST can reliably predict the onset of plasma leakage in dengue, a low-cost triage tool during epidemics

Platelet count and AST can reliably predict the onset of plasma leakage in dengue, a low-cost triage tool during epidemics

Predictors of plasma leakage among dengue patients in Thailand: A plasma-leak score analysis

Platelet count and AST can reliably predict the onset of plasma leakage in dengue, a low-cost triage tool during epidemics

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