Clinical manifestations and predictors of thrombocytopenia in hospitalized adults with dengue fever

Abstract

Background:India is one of the seven identified Southeast Asian countries reporting frequent outbreaks of dengue fever (DF).Aims:This study was to analyze clinical and laboratory profile and predictive markers of thrombocytopenia and length of hospital stay in DF.Materials and Methods:This record-based retrospective study conducted in a coastal district of Karnataka, South India, included all dengue cases in adults aged >18 years, admitted during period of January 2011 to December 2014. Multivariate logistic regression analysis was carried out to compute odds ratio (OR) and 95% confidence interval (CI) to assess independent associations of variables with low platelet count and longer duration of hospital stay.Results:Among 207 dengue immunoglobulin M (IgM) antibody confirmed cases (mean age of 36.94 ± 14.61 years), 143 (69.1%) were males and 64 were females. The mean duration of illness and hospital stay were 4.94 ± 3.58 days and 5.98 ± 2.58 days, respectively. Abdominal symptoms included nausea and vomiting (53.6%), abdominal pain (25.1%), and diarrhea (13.5%). Bleeding manifestations were seen in 24 (11.6%) cases and fluid accumulation was revealed in 18 (8.7%) cases. The mean platelet count was 110,159.42 ± 68,397.32 (cells/mm3). Low platelet count on admission was associated with the presence of rash (OR = 0.43, 95% CI 0.23-0.81), high aspartate aminotransferase (AST) levels (OR = 3.14, 95% CI 1.58-6.23), high alanine aminotransferase (ALT) levels (OR = 2.91, 95% CI 1.55-5.47), and low albumin levels (OR = 4.48, 95% CI 1.02-19.75). The duration of hospital stay was associated with diarrhea (OR = 0.4, 95% CI 0.18-0.9), abdominal pain (OR = 0.52, 95% CI 0.27-1.00), ascites (OR = 0.26, 95% CI 0.09-0.69), and low hemoglobin (OR = 0.46, 95% CI 0.25-0.86) level on admission.Conclusions:Though thrombocytopenia on admission was associated with the presence of rash, high AST and ALT levels, and low albumin levels, it was not predictive of length of hospitalization. Duration of hospital stay was longer with the presence of diarrhea, abdominal pain, ascites, and low hemoglobin level on admission.

Predictors of Prolonged Hospitalization in Patients with Fever

“…Prolonged hospitalization was found to be associated with lower Hb levels and a higher blood neutrophil fraction on admission [ 9 ]. A similar finding for low Hb was seen in another study as well [ 10 ].…”

“…In our study, thrombocytopenia was significantly associated with a longer hospital stay but this was not the case in some earlier studies [ 10 , 18 ]. This is possibly because both of these studies looked only at specific causes of fever that can be related to lower platelet counts in advanced stages.…”

Factors associated with thrombocytopenia in patients with dengue fever: a retrospective cohort study

“…31 Other study involving only inpatients with dengue fever also exhibited similar platelet rates. 22 Thrombocytopenia (<1 00×10 9 /L) is less common in patients with dengue than in inpatients with other arbovirus infections. 31–34 This discrepancy is attributed to the pattern of platelet counts over time in patients with dengue fever; the count is typically lowest between 3 and 6 days after the onset of illness, just before the fever begins to subside.…”

Dengue durante el embarazo, menor incidencia de trombocitopenia que en la población general

“…En contraste, en el grupo de pacientes embarazadas, la fiebre fue el síntoma más frecuente. La incidencia de otros síntomas como mialgias y artralgias fue semejante a la encontrada en estudios previos (16,17). Algunos autores (16,18,19) han encontrado mayor incidencia de esta infección en pacientes del sexo masculino, hecho que contrasta con los resultados obtenidos en el presente estudio, en donde observamos mayor incidencia en mujeres (57% vs. 43%).…”