Prognostic Factors of Severe Dengue Infections in Children

Abstract

The incidence of dengue fever increase annually and can increase morbidity and mortality. Dengue fever is mosquito-borne disease and caused by one of four serotype dengue viruses. Severe dengue is characterized either by plasma leakage, fluid accumulation, respiratory distress, severe bleeding, or organ impairment. Mortality and serious morbidity of dengue were caused by several factors including the late recognition of the disease and the changing of clinical signs and symptoms. Understanding the prognostic factors in severe dengue will give early warning to physician thus decreasing the morbidity and mortality, and also improving the treatment and disease management. The aim of this study was to analyze the prognostic factors of severe dengue infection in children. This study was observational cohort study in children (2 months-18 years) with dengue infection according to WHO 2009 criteria which admitted in Soetomo and Soewandhie Hospital Surabaya. Analysis with univariate, bivariate and multivariate with IBM SPSS Statistic 17. All patients were confirmed by serologic marker (NS-1 or IgM/IgG Dengue). Clinical and laboratory examination such as complete blood count, aspartate aminotrasnferase (AST), alanine aminotrasferase (ALT), albumin, and both partial trombocite time and activated partial trombosit time (PTT and aPPT) were analyzed comparing nonsevere dengue and severe dengue patients. There were 40 subjects innonsevere and 27 subjects with severe dengue infection. On bivariate analysis, there were significant differences of nutritional status, abdominal pain, petechiae, pleural effusion, leukopenia, thrombocytopenia, hypoalbuminemia, history of transfusion, increasing AST>3x, prolonged PPT and APTT between severe and nonsevere dengue group. After multivariate analyzed, the prognostic factors of severe dengue were overweight/obesity (p=0.003, RR 94), vomiting (p=0.02, RR 13.3), hepatomegaly (p=0.01, RR=69.4), and prolonged APTT (p=0.005, RR=43.25). In conclusion, overweight/obesity, vomiting, hepatomegaly, and prolonged APTT were prognostic factors in severe dengue infection in children.Those factors should be monitored closely in order to reduce the mortality and serious morbidity.

Evaluating the importance of clinical manifestations and laboratory parameters associated with progression to severe dengue in children

“…After including two studies in the metaanalysis, we obtained an OR of 1.02 (95%CI 0.60 to 1.75) with no heterogeneity (I2=0%). 33,48 In terms of clinical manifestations, we found that neurologic signs were strongly associated with the progression of severe dengue. Neurological manifestations may include drowsiness, convulsions, decreased consciousness, or lethargy.…”

“…Three studies reported an association between nutritional status and progression to severe dengue. 33,48,59 Baiduri et al 33 showed a strong relationship between overweight-obesity and progression to severe dengue with an RR of 94 (95%CI 4.47 to 1989) through a multivariate analysis approach. Tantracheewathorn et al 48 and Dewi et al 59 found no association between normal nutritional status and progression to severe dengue.…”

Disseminated intravascular coagulation initial score as a predictor of mortality in children with dengue shock syndrome: A retrospective cohort study

“…No statistical significance occurred because all research subjects showed PT prolongation >6 s so it was not possible to know the PT value that played a role as predictor factor in mortality. However, PT played a role in patient survival in the first 6 h, which was 94.1% of patients were still alive and decreased to 82.4% at 24 h. This shows that PT prolongation is closely related to the presence of an unresolved shock process [ 12 ].…”

“…A rapid decrease in thrombocyte count is associated with the severity of dengue virus infection as observed in this study, in which 93.8% of patients with a thrombocyte count 50,000/L in the first 6 h after DSS diagnosis were still alive but decreased to 81.3% after 24 h of treatment. This is closely related to bleeding manifestations, such as gastrointestinal bleeding that occurs in 58.8% of patients [ 12 ].…”