Early hematological parameters as predictors for outcomes in children with dengue in northern India: A retrospective analysis

Abstract

INTRODUCTION: Dengue presents with a variable clinical course, ranging from mild illness to potentially fatal hemorrhage and shock. We aimed to evaluate the capabilities of various hematological parameters observed early in the course of illness for predicting the clinical outcomes of illness. METHODS: We retrospectively analyzed the records of children admitted in the pediatric inpatient services of the institute with dengue between 2017 and 2019. We determined the relationships between the hematological parameters observed during the first evaluation and the various clinical outcomes. RESULTS: We evaluated data from 613 patients (age range, 26 days to 17 years). Of these, 29.85% exhibited fever with warning signs, and 8.97% had severe dengue. Lower values of hemoglobin, platelet count, mean corpuscular volume, mean corpuscular hemoglobin concentration, and mean platelet volume, and higher values of total leukocyte count (TLC), hematocrit, and red cell distribution width variably correlated with numerous clinical outcomes-duration of hospital stay, development of complications, requirement of blood component transfusion, inotropic support, and mortality. Among the parameters, TLC ≥20,000/mL and initial platelet count ≤20,000/mL significantly associated with mortality, with odds ratios (95% confidence interval) of 11.81 (4.21-33.80) and 5.53 (1.90-16.09), respectively. CONCLUSIONS: Hematological parameters observed early during dengue infection may predict its clinical outcomes in infected children. Initial high TLC and low platelet count are potential predictors of fatal outcomes in the course of disease.

A study on predictors of severe dengue in pediatric patients in a tertiary care hospital in Telangana

“…Similar observations were made by Mishra et al [7] and Majeed et al [13]. However, Nandwani et al [12] noted that severe dengue and complications were more in female children.…”

“…We observed that majority were from 5 to 10 years age group. This may be due to more outdoor activities by children of this age group and relatively more uncovered area and hence more prone for mosquito bites [9][10][11][12]. Male children (61.5%) were more commonly affected by dengue fever than female children.…”

“…Thrombocytopenia (<50,000/mm 3 ) and hematocrit rise ≥20% from baseline or mean of population were also noted in our study. Nandwani et al [12] observed that low hemoglobin, high total leukocyte count (TLC), and low platelet were associated with severe outcome. A study by Tanner et al [22] from Singapore emphasized that platelet count <50,000/mL early in the illness associated with poor prognosis during the clinical course.to be changed to -In a study by Srilanka by Kularatnam et al [23], a total leucocyte count of less than 2.6×10 9 /L and platelet count less than 100×10 9 /L at day 2.5 was highly suggestive of child progressing into DHF.…”

Machine-learning based prediction of prognostic risk factors in patients with invasive candidiasis infection and bacterial bloodstream infection: a singled centered retrospective study

“…In addition, this study shows that increased leukocyte counts indicate increased mortality in hospitalised patients with infection. Similar studies have shown that the death rate of patients with cancer and dengue increases with increasing leukocyte counts [ 41 , 42 ]. Infections destroy the dynamic balance of the immune system and cause significant changes in the neutrophil count, which are closely related to mortality [ 43 , 44 ].…”

Successful Outpatient Management of Children at a Secondary Care Hospital in Pakistan in a Dengue Fever Epidemic and Their Clinical Outcomes

“…Also, the patients who deteriorated later had mean TLC and PLT counts near the lower limit of normal at initial presentation compared to patients with DF who did not progress to SD. Similarly, high HCT and low PLT were reported to be significantly associated as risk factors in the febrile phase for progression to severe disease from recent systematic reviews and meta-analyses [ 17 , 19 ] and other studies [ 20 ]. Tachypnea as a significant factor in these patients could be because of high grade fever or early sign of fluid accumulation in this group as compared to the other group [ 3 ].…”