Clinical relevance of gallbladder wall thickening for dengue severity: A cross-sectional study

Abstract

Dengue fever is the most important arthropod-borne viral infection worldwide. Secondary prevention to reduce mortality through improved clinical case management has substantially lowered the mortality rate for severe dengue during the past two decades. Gallbladder wall thickening (GBWT) is a nonspecific finding often associated with more severe cases of dengue infection. This study had the aim to describe the ultrasonographic findings in hospitalized patients with dengue infection from Manaus (in the Western Brazilian Amazon) and to correlate the GBWT with dengue severity, symptoms and laboratorial analysis. Patients from 13–84 years admitted to the emergency department at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD) were enrolled in this study. Patients’ selection occurred during the most recent and huge dengue outbreak within the first semester of 2011. All enrolled subjects were systematically tested in order to rule out other possible etiologies for gallbladder inflammation. Abdominal ultrasound was performed by a single physician through bedside portable equipment and all other clinical and laboratorial information were retrieved from patients’ electronic files. 54 subjects were considered for analysis, with confirmed dengue infection by NS1 and/or RT-PCR positivity. From all enrolled patients, 50 (42.4%) presented GBWT. GBWT was significantly and independently related to: age under 31 years, pregnancy, presence of bleeding, presence of any cavitary effusion, DHF classification and severe dengue classifications. During dengue outbreaks, the GBWT identification through a non-invasive and bedside procedure is a confident marker for prompt recognition of potential severe cases.

Gall Bladder Wall Thickening in Dengue Fever – Aid in Labelling Dengue Hemorrhagic Fever and a Marker of Severity

“…In our study, mean value of platelets in patients with GBWT is 48. [21][22][23][24]. According to our study results, hematocrit shows no statistically significant association with GBWT (p=0.258), which is in line with the recent evidence that hematocrit is a poor indicator of the severity of dengue infection [25].…”

“…In our study, mean value of platelets in patients with GBWT is 48.1 ± 17.3 x103 cells/µl (p-value <0.001). Manam G et al, Bajaj S et al, and Nagolu H et al support this fact statistically; however, Tavares MdA et al show no association of GBWT with platelet count or other hematological parameters [ 21 - 24 ]. According to our study results, hematocrit shows no statistically significant association with GBWT (p=0.258), which is in line with the recent evidence that hematocrit is a poor indicator of the severity of dengue infection [ 25 ].…”

Coronavirus disease 2019 and dengue: two case reports

“…With a depleting trend of leukocytes and platelets, dengue serology was performed, which was positive. Case 1 had a hemoconcentration of 19% and gall bladder wall edema suggestive of plasma leakage [47]. As there was no bleeding manifestation, this case was classified as DHF grade 1 [48].…”

Predictive Analysis of Gallbladder Wall Thickness as a Marker for Bleeding Risk and Need for Transfusion in Dengue Patients

“…wall thickening (GBWT) is one manifestation of increased capillary permeability and can be detected by a bedside abdominal ultrasound (5).…”

“…GBWT was the primary variable of the study along with documentation of outcomes like length of hospital stay, platelet counts on admission, lowest platelet count during the hospital stay, days to reach lowest count, bleeding event (major or minor) and transfusion of platelets during the hospital stay. GBWT correlates with clinical fluid accumulation (third spacing) and is usually higher when the patient is in hypovolemia; show a progressive increase between days 3 to 8 of illness (5). The criteria for platelet transfusion were either a platelet count of less than 20 x 10 9 /L in an ongoing febrile illness, or a platelet count of less than 10 x 10 9 /L regardless of febrile illness, and other than that a bleeding event regardless of platelet counts.…”