Predictive factors of dengue severity in hospitalized children and adolescents in Rio de Janeiro, Brazil

Ferreira, Ralph Antonio Xavier; Kubelka, Claire Fernandes; Velarde, Luís Guillermo Coca; Matos, Jorge Paulo Strogoff de; Ferreira, Laura Cunha; Reid, Mariana Mancebo; Setúbal, Sérgio; Oliveira, Solange Artimos de

doi:10.1590/0037-8682-0036-2018

Cited by 13 publications

(9 citation statements)

References 20 publications

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“…Several retrospective and prospective studies have reported the value of specific clinical and early laboratory parameters to identify patients at risk of progressing to severe dengue. [19][20][21][22][23][24] Among the clinical predictors, many studies report age, presence of comorbidities, nutritional status, and the presence of specific clinical features on admission as predictive of DHF or severe dengue. [19][20][21][22][23][24] In addition, simple laboratory parameters also have been shown to be predictive of severe disease.…”

Section: Plos Neglected Diseasesmentioning

confidence: 99%

“…[19][20][21][22][23][24] Among the clinical predictors, many studies report age, presence of comorbidities, nutritional status, and the presence of specific clinical features on admission as predictive of DHF or severe dengue. [19][20][21][22][23][24] In addition, simple laboratory parameters also have been shown to be predictive of severe disease. [19,21,24] More recently, sophisticated biomarkers such as chymase and predictive gene sets have also been shown to identify patients who may progress to developing severe dengue.…”

Section: Plos Neglected Diseasesmentioning

confidence: 99%

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Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden

et al. 2021

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Background Healthcare systems in dengue-endemic countries are often overburdened due to the high number of patients hospitalized according to dengue management guidelines. We systematically evaluated clinical outcomes in a large cohort of patients hospitalized with acute dengue to support triaging of patients to ambulatory versus inpatient management in the future. Methods/Principal findings From June 2017- December 2018, we conducted surveillance among children and adults with fever within the prior 7 days who were hospitalized at the largest tertiary-care (1,800 bed) hospital in the Southern Province, Sri Lanka. Patients who developed platelet count ≤100,000/μL (threshold for hospital admission in Sri Lanka) and who met at least two clinical criteria consistent with dengue were eligible for enrollment. We confirmed acute dengue by testing sera collected at enrollment for dengue NS1 antigen or IgM antibodies. We defined primary outcomes as per the 1997 and 2009 World Health Organization (WHO) classification criteria: dengue hemorrhagic fever (DHF; WHO 1997), dengue shock syndrome (DSS; WHO 1997), and severe dengue (WHO 2009). Overall, 1064 patients were confirmed as having acute dengue: 318 (17.4%) by NS1 rapid antigen testing and 746 (40.7%) by IgM antibody testing. Of these 1064 patients, 994 (93.4%) were adults ≥18 years and 704 (66.2%) were male. The majority (56, 80%) of children and more than half of adults (544, 54.7%) developed DHF during hospitalization, while 6 (8.6%) children and 22 (2.2%) adults developed DSS. Overall, 10 (14.3%) children and 113 (11.4%) adults developed severe dengue. A total of 2 (0.2%) patients died during hospitalization. Conclusions One-half of patients hospitalized with acute dengue progressed to develop DHF and a very small number developed DSS or severe dengue. Developing an algorithm for triaging patients to ambulatory versus inpatient management should be the future goal to optimize utilization of healthcare resources in dengue-endemic countries.

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Section: Plos Neglected Diseasesmentioning

confidence: 99%

Section: Plos Neglected Diseasesmentioning

confidence: 99%

Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden

et al. 2021

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“…To ensure that the increase in kidney weight was not solely a result of body weight gain, the kidney weight/body weight ratio (%) was calculated, and means of the infected group were also higher than control group. Despite that, to our knowledge, there are no reports of kidney weight increase due to DENV infection, liver, spleen and pancreas weight increases during DENV infection, and hepatomegaly, splenomegaly and pancreatic enlargement have been associated with dengue [ 70 , 71 , 72 , 73 ].…”

Section: Discussionmentioning

confidence: 99%

Brazilian Dengue Virus Type 2-Associated Renal Involvement in a Murine Model: Outcomes after Infection by Two Lineages of the Asian/American Genotype

et al. 2021

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Dengue virus type 2 (DENV-2) is, traditionally, the most studied serotype due to its association with explosive outbreaks and severe cases. In Brazil, almost 20 years after the first introduction in the 1990s, a new lineage (Lineage II) of the DENV-2 Asian/American genotype emerged and caused an epidemic with severe cases and hospitalizations. Severe dengue includes multiple organ failure, and renal involvement can be potentially related to increased mortality. In order to better understand the role of DENV infection in renal injury, here we aimed to investigate the outcomes of infection with two distinct lineages of DENV-2 Asian/American genotype in the kidney of a murine model. BALB/c mice were infected with Lineages I and II and tissues were submitted to histopathology, immunohistochemistry, histomorphometry and ultrastructural analysis. Blood urea nitrogen (BUN) was detected in blood sample accessed by cardiac puncture. A tendency in kidney weight increase was observed in mice infected with both lineages, but urea levels, on average, were increased only in mice infected with Lineage II. The DENV antigen was detected in the tissue of mice infected with Lineage II and morphological changes were similar to those observed in human dengue cases. Furthermore, the parameters such as organ weight, urea levels and morphometric analysis, showed significant differences between the two lineages in the infected BALB/c, which was demonstrated to be a suitable experimental model for dengue pathophysiology studies in kidneys.

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“…First, although the early alterations of platelets and AST levels indicate a higher risk of severe dengue development, these indicators require establishing quantitative diagnostic values and additional validation through prospective studies. Finally, decreased platelet counts in the first 72 hours could serve as an independent warning sign, instead of combining with elevated hematocrit detectable when plasma leak has implicitly occurred, often on day 3 or around the critical phase [61,74,[131][132][133].…”

Section: Discussionmentioning

confidence: 99%

Predictive markers for the early prognosis of dengue severity: A systematic review and meta-analysis

et al. 2021

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Background Predictive markers represent a solution for the proactive management of severe dengue. Despite the low mortality rate resulting from severe cases, dengue requires constant examination and round-the-clock nursing care due to the unpredictable progression of complications, posing a burden on clinical triage and material resources. Accordingly, identifying markers that allow for predicting disease prognosis from the initial diagnosis is needed. Given the improved pathogenesis understanding, myriad candidates have been proposed to be associated with severe dengue progression. Thus, we aim to review the relationship between the available biomarkers and severe dengue. Methodology We performed a systematic review and meta-analysis to compare the differences in host data collected within 72 hours of fever onset amongst the different disease severity levels. We searched nine bibliographic databases without restrictive criteria of language and publication date. We assessed risk of bias and graded robustness of evidence using NHLBI quality assessments and GRADE, respectively. This study protocol is registered in PROSPERO (CRD42018104495). Principal findings Of 4000 records found, 40 studies for qualitative synthesis, 19 for meta-analysis. We identified 108 host and viral markers collected within 72 hours of fever onset from 6160 laboratory-confirmed dengue cases, including hematopoietic parameters, biochemical substances, clinical symptoms, immune mediators, viral particles, and host genes. Overall, inconsistent case classifications explained substantial heterogeneity, and meta-analyses lacked statistical power. Still, moderate-certainty evidence indicated significantly lower platelet counts (SMD -0.65, 95% CI -0.97 to -0.32) and higher AST levels (SMD 0.87, 95% CI 0.36 to 1.38) in severe cases when compared to non-severe dengue during this time window. Conclusion The findings suggest that alterations of platelet count and AST level—in the first 72 hours of fever onset—are independent markers predicting the development of severe dengue.

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Predictive factors of dengue severity in hospitalized children and adolescents in Rio de Janeiro, Brazil

Cited by 13 publications

References 20 publications

Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden

Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden

Brazilian Dengue Virus Type 2-Associated Renal Involvement in a Murine Model: Outcomes after Infection by Two Lineages of the Asian/American Genotype

Predictive markers for the early prognosis of dengue severity: A systematic review and meta-analysis

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