A Prognostic Model for Development of Profound Shock among Children Presenting with Dengue Shock Syndrome

Abstract

PurposeTo identify risk factors and develop a prediction model for the development of profound and recurrent shock amongst children presenting with dengue shock syndrome (DSS)MethodsWe analyzed data from a prospective cohort of children with DSS recruited at the Paediatric Intensive Care Unit of the Hospital for Tropical Disease in Ho Chi Minh City, Vietnam. The primary endpoint was “profound DSS”, defined as ≥2 recurrent shock episodes (for subjects presenting in compensated shock), or ≥1 recurrent shock episodes (for subjects presenting initially with decompensated/hypotensive shock), and/or requirement for inotropic support. Recurrent shock was evaluated as a secondary endpoint. Risk factors were pre-defined clinical and laboratory variables collected at the time of presentation with shock. Prognostic model development was based on logistic regression and compared to several alternative approaches.ResultsThe analysis population included 1207 children of whom 222 (18%) progressed to “profound DSS” and 433 (36%) had recurrent shock. Independent risk factors for both endpoints included younger age, earlier presentation, higher pulse rate, higher temperature, higher haematocrit and, for females, worse hemodynamic status at presentation. The final prognostic model for “profound DSS” showed acceptable discrimination (AUC=0.69 for internal validation) and calibration and is presented as a simple score-chart.ConclusionsSeveral risk factors for development of profound or recurrent shock among children presenting with DSS were identified. The score-chart derived from the prognostic models should improve triage and management of children presenting with DSS in dengue-endemic areas.

The value of daily platelet counts for predicting dengue shock syndrome: Results from a prospective observational study of 2301 Vietnamese children with dengue

“…Interestingly, we did not find evidence of a relationship between haematocrit and risk of progression to DSS, even though haematocrit but not platelet count was a strong predictor of severe outcome in our study of children with established DSS [21]. Thus the platelet count and haematocrit seem to be relevant for risk prediction during different stages of the disease.…”

Diagnostic accuracy and predictive value in differentiating the severity of dengue infection

“…A total of 26 included studies conducted between 1994 and 2017 were published between 2008 and 2018 . However, two studies were related, leaving a total of 25 studies of different settings .…”

Miocarditis en la infección viral del dengue en pediatría.

“…El sexo femenino se ha identificado como un predictor dependiente de mortalidad en niños con DSS, posiblemente reflejando una mayor permeabilidad intrínseca vascular, y por lo tanto una mayor susceptibilidad al síndrome de fuga capilar, en las mujeres que en los hombres. Existe asociación bien establecida entre la fuga vascular y trombocitopenia, aunque es probable que la trombocitopenia ya presente en el inicio del choque enmascare otras manifestaciones graves [18].…”

“…La característica patognomónica de la vasculopatía asociada al DENV grave es el incremento de la permeabilidad vascular que provoca un síndrome de fuga capilar transitoria. La descompensación cardiovascular se produce cuando las pérdidas de plasma exceden la capacidad de regulación [18]. Y no son suficientes los mecanismos de compensación normales que mantienen el volumen plasmático dentro del límite del sistema vascular [40].…”

“…En los casos graves, la fuga plasmática puede hacer colapsar el sistema cardiovascular desencadenando consecuencias potencialmente fatales, y DSS[1].En la población pediátrica se debe optimizar el manejo durante el curso clínico de la enfermedad. Varios estudios han demostrado un mayor riesgo de fuga vascular y desarrollo de DSS en los niños en comparación con los adultos,[18,19,20], probablemente relaciona-…”