Effectiveness of corticosteroid in the treatment of dengue – A systemic review

Bandara, Senanayake Mudiyanselage Rathnasiri; Herath, H. M. M. T. B.

doi:10.1016/j.heliyon.2018.e00816

Cited by 22 publications

(19 citation statements)

References 20 publications

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“…A recent systematic review showed that corticosteroids given to reduce the degree of inflammation in the period between CLS and DSS had a survival benefit[ 32 ] in dengue; however, there has been no study of their use in a subgroup of patients with ALF. One patient in our study received corticosteroids; unfortunately, she did not survive.…”

Section: Discussionmentioning

confidence: 99%

Acute liver failure and death predictors in patients with dengue-induced severe hepatitis

Teerasarntipan¹,

Chaiteerakij²,

Komolmit³

et al. 2020

WJG

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BACKGROUND Liver injury in patients with dengue infection is common. Most patients have mild and transient hepatitis. Acute liver failure (ALF) in dengue infection is rare but results in an extremely poor prognosis. AIM To identify prognostic predictors of ALF and death in patients with dengue-induced severe hepatitis (DISH). METHODS We retrospectively reviewed 2311 serologically confirmed adolescent and adult dengue patients who were hospitalized during a 12-year study period (between 2007 and 2019) at the university hospital of King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Patients with DISH [ n = 134 (5.80%)], defined as a baseline transaminase > 10 times the normal reference cut-off level, and DISH with subsequent ALF as defined by the American Association for the Study of the Liver Diseases 2011 criteria [ n = 17 (0.74%)], were included. Predictors of ALF and in-hospital death were identified using logistic regression analysis. RESULTS Of the 151 dengue-infected patients with severe liver injury or ALF, 51% were female, with a mean age of 27.9 ± 14.5 years. Capillary leakage syndrome (CLS) occurred in 68.2% ( n = 103) of DISH and 100% of ALF patients. The mortality rate was low in DISH patients (0.8%) but was remarkably high if ALF developed (58.8%). In univariate analysis, age, sex, hematocrit, white blood count, atypical lymphocyte count, platelet count, international normalized ratio (INR), bilirubin, serum glutamate-oxaloacetate transaminase, serum glutamate-pyruvate transaminase, alkaline phosphatase, albumin, creatinine, Model for End-Stage Liver Disease (MELD) score, presence of liver comorbidity and presence of CLS were identified as potential prognostic parameters for ALF or death. In multivariate analysis, the MELD score remained the only predictor of ALF with an adjusted odds ratio (aOR) of 1.3 [95% confidence interval (CI): 1.1-1.5; P = < 0.001]. An initial MELD score ≥ 15 was associated with ALF from DISH with an area under the receiver operating characteristic (AUROC) of 0.91, 88.2% sensitivity and 87.3% specificity. Regarding mortality prediction, the deterioration of liver function to ALF was the most significant factor related to death in DISH patients (aOR 108.5, 95%CI: 5.5-2145.4, P = 0.002). Other independent factors associated with death included baseline INR (aOR 10.4, 95%CI: 2.6-40.5, P = 0.001). An INR ≥ 1.5 predicted death from DISH with an AUROC of 0.83 (81.8% sensitivity and 86.8% specificity). CONCLUSION The MELD score is the best predictor of ALF in DISH patients, a complication from dengue that is associated with high mortality. The presence of ALF and the baseline INR level are independent markers of death in DISH patients.

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Section: Discussionmentioning

confidence: 99%

Acute liver failure and death predictors in patients with dengue-induced severe hepatitis

Teerasarntipan¹,

Chaiteerakij²,

Komolmit³

et al. 2020

WJG

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“…Additional evidence that immunosuppression does not worsen outcome comes from large scale trials in dengue, a related flavivirus. A comprehensive review that included 13 studies enrolling 1293 participants on the effectiveness of corticosteroids in the treatment of dengue, found no evidence that administration of high doses of oral or intravenous corticosteroids promoted viremia [180]. Rather, therapeutic benefit was seen in multiple studies that used intravenous delivery of high doses and multiple doses of steroids.…”

Section: Immunotherapeutic Interventionmentioning

confidence: 99%

Current Understanding of West Nile Virus Clinical Manifestations, Immune Responses, Neuroinvasion, and Immunotherapeutic Implications

et al. 2019

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West Nile virus (WNV) is the most common mosquito-borne virus in North America. WNV-associated neuroinvasive disease affects all ages, although elderly and immunocompromised individuals are particularly at risk. WNV neuroinvasive disease has killed over 2300 Americans since WNV entered into the United States in the New York City outbreak of 1999. Despite 20 years of intensive laboratory and clinical research, there are still no approved vaccines or antivirals available for human use. However, rapid progress has been made in both understanding the pathogenesis of WNV and treatment in clinical practices. This review summarizes our current understanding of WNV infection in terms of human clinical manifestations, host immune responses, neuroinvasion, and therapeutic interventions.

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“…The use of steroids is still controversial and not widely recommended, as several studies have shown that they do not affect clinical outcomes such as mortality. 33 The observed increased prescription of anti-inflammatories in patients with comorbidities (adjOR: 6.2, 95% CI: 1.5-24.5) may be due to the fact that most comorbidities were respiratory (3.3%) and rheumatological (1.5%), in which the use of anti-inflammatory drugs could be indicated, as is the case of exacerbated asthma or arthritis.…”

Section: Discussionmentioning

confidence: 99%

Impact of Dengue Rapid Diagnostic Tests on the Prescription of Antibiotics and Anti-Inflammatory Drugs by Physicians in an Endemic Area in Colombia

Tello-Cajiao

Osório

2019

The American Journal of Tropical Medicine and Hygiene

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There is insufficient evidence on whether dengue rapid diagnostic tests (dRDTs) influence clinical decisions in endemic areas. Therefore, our objective was to evaluate the impact of dRDTs on the prescription of antibiotics and antiinflammatory drugs by physicians in a dengue-endemic area in Colombia. A retrospective cohort study was conducted with 330 patients in Cali, Colombia, between January 2012 and December 2017. The exposure was defined by the result of the dRDT. The outcomes were prescription of antibiotics and anti-inflammatory drugs after results of dRDT. Incidence and RR with 95% CIs were estimated. Multivariate logistic regression models were fitted separately for each outcome. Antibiotics were prescribed in 3% exposed and 14% unexposed. Anti-inflammatory drugs were prescribed in 1.2% exposed and 7.9% unexposed. A positive dRDT reduced the prescription of anti-inflammatories (AdjOR: 0.06, 95% CI: 0.008-0.5) but, by itself, had no effect on antibiotics (AdjOR: 1.1, 95% CI: 0.2-6); however, in hospitalized patients, a positive result reduced the probability of antibiotic prescription (AdjOR: 0.02, 95% CI: 0.00-0.8). Despite limitations of current dRDTs, they influence treatment decisions. Further studies are needed to assess the effect of dRDTs in patient outcomes and health-care costs.

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Effectiveness of corticosteroid in the treatment of dengue – A systemic review

Cited by 22 publications

References 20 publications

Acute liver failure and death predictors in patients with dengue-induced severe hepatitis

Acute liver failure and death predictors in patients with dengue-induced severe hepatitis

Current Understanding of West Nile Virus Clinical Manifestations, Immune Responses, Neuroinvasion, and Immunotherapeutic Implications

Impact of Dengue Rapid Diagnostic Tests on the Prescription of Antibiotics and Anti-Inflammatory Drugs by Physicians in an Endemic Area in Colombia

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