Development of clinical decision rules to predict recurrent shock in dengue

Abstract

IntroductionMortality from dengue infection is mostly due to shock. Among dengue patients with shock, approximately 30% have recurrent shock that requires a treatment change. Here, we report development of a clinical rule for use during a patient’s first shock episode to predict a recurrent shock episode.MethodsThe study was conducted in Center for Preventive Medicine in Vinh Long province and the Children’s Hospital No. 2 in Ho Chi Minh City, Vietnam. We included 444 dengue patients with shock, 126 of whom had recurrent shock (28%). Univariate and multivariate analyses and a preprocessing method were used to evaluate and select 14 clinical and laboratory signs recorded at shock onset. Five variables (admission day, purpura/ecchymosis, ascites/pleural effusion, blood platelet count and pulse pressure) were finally trained and validated by a 10-fold validation strategy with 10 times of repetition, using a logistic regression model.ResultsThe results showed that shorter admission day (fewer days prior to admission), purpura/ecchymosis, ascites/pleural effusion, low platelet count and narrow pulse pressure were independently associated with recurrent shock. Our logistic prediction model was capable of predicting recurrent shock when compared to the null method (P < 0.05) and was not outperformed by other prediction models. Our final scoring rule provided relatively good accuracy (AUC, 0.73; sensitivity and specificity, 68%). Score points derived from the logistic prediction model revealed identical accuracy with AUCs at 0.73. Using a cutoff value greater than −154.5, our simple scoring rule showed a sensitivity of 68.3% and a specificity of 68.2%.ConclusionsOur simple clinical rule is not to replace clinical judgment, but to help clinicians predict recurrent shock during a patient’s first dengue shock episode.

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

“…Although both models were based on Vietnamese children with DSS, our model differs from the only other published prediction model for recurrent shock in several respects. [ 15 ] We used data from 1207 patients from a single hospital, whereas in Huy’s study data of 444 patients from two very different health care settings were combined (a preventive health-care centre of a small province and a large referral hospital in a big city) although without reporting site-specific summaries. It is difficult to compare the models, as the reported proportions of patients with purpura/ecchymosis (36% vs. 3%) and ascites/pleural effusion (44% vs. 1%) were markedly different.…”

“…[ 24 ] We also assessed the performance of the prognostic model for recurrent shock developed by Huy et al using our dataset. [ 15 ]…”

“…Although a number of models have examined risk factors for development of shock among individuals with dengue, [ 13 , 14 ] to date only a single report describes a prognostic model for poor outcome in patients with established DSS. [ 15 ] In this study, we analyzed data from a much larger cohort of children (n = 1207) presenting with DSS to a single hospital, aiming to identify risk factors for profound shock, and to develop a robust prognostic model to assist physicians in identifying children likely to require intensive supportive therapy.…”

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 .…”

Validation of Decision Groups in Patients with Dengue Fever: A Study during 2015 Outbreak in Taiwan

“…17,18 In 2013, a study in Vietnam developed a clinical decision rule to predict recurrent shock in DF. 19 This study proposed the following five independent predictors for recurrent shock: admission day, purpura/ecchymosis, ascites/pleural effusion, blood platelet count, and pulse pressure. 19 All the abovementioned three methods have the advantage of more clearcut decision points and provided another choice for clinical practice; however, further validation with more patients and other nations is warranted.…”