Factors Associated With Severity of Illness in Patients With Dengue Fever in a Tertiary Care Hospital in Southern India

Abstract

Objective: Denguefeveris one of the important tropical disease of public health significance caused by flavivirus. It is a major cause of morbidity and mortality worldwide. Identification of factors associated with severity of dengue can improve the prognosis of the disease.This study tried toassess the factors associated with severity of dengue. Methods:A record based study was conducted in a tertiary care hospital setting in southern India. A total of 550 case files were reviewed to ascertain demographic, clinical and laboratory parameters among confirmed cases of dengue. The severity of dengue was categorized using WHO 2009 classification.Results: Of 550 records reviewed, 449 (81.6%) were classified as non-severe dengue and 101 (18.4%) as severe dengue. Factors associated with severe dengue on univariate analysis were: gender, backache, skin rash, nausea and vomiting, abdominal distension, haemorrhage, breathlessness, oliguria, hepatomegaly, splenomegaly, ascites, leukopenia, hypoproteinemia, and elevated serum alanine transaminase (ALT) >63 IU/L.On multivariate analysis,haemorrhage (OR=11.75, 95%; CI=6.38-21.62), oliguria (OR=4.01, 95%; CI=1.32-12.15), ascites (OR=2.68, 95%; CI=1.19-6.01), ALT>63 IU/L (OR=1.77, 95%; CI=1.01-3.1) and hypoproteinemia (OR=5.57, 95%; CI=2.82-10.98) were found to have significant association with the development of severe dengue. Conclusion:This study indicates thatwhen dengue patients present with bleeding episodes, ascites, oliguria,raised ALT and low serum protein levels, clinicians should be alert to the appearance of severe complications. Early identification of these factors will help clinicians to recognise the severity of dengue illness and enable them to implement appropriate interventions.

Clinical signs and symptoms associated with WHO severe dengue classification: a systematic review and meta-analysis

“…A total of 207 full-text articles were excluded for the reasons mentioned in the study flow chart (Figure 2). Finally, 39 articles [2,[7][8][9][10] were selected for inclusion in this meta-analysis according to the WHO classification for dengue, namely dengue without warning signs, dengue with warning signs and severe dengue, as well as unclassified signs or laboratory features. The date set for searching was 2009, all the studies were published after 2009.…”

“…However, there was a question for applicability in clinical practice and usefulness for triage using the revised dengue classification [6]. Several studies have assessed the association of clinical factors with severe dengue [7][8][9][10].…”

“…However, risk factors reported among severe dengue patients remained inconsistent [7][8][9][10]. The objective of this review was to synthesize the best of available evidence by conducting metaanalysis to assess the factors associated with severe dengue patients.…”