Assessment of the new World Health Organization's dengue classification for predicting severity of illness and level of healthcare required

Abstract

The objective of this study was to assess the validity of the new dengue classification proposed by the World Health Organization (WHO) in 2009 and to develop pragmatic guidelines for case triage and management. This retrospective study involved 357 laboratory-confirmed cases of dengue infection diagnosed at King Abdulaziz University Hospital, Jeddah, Saudi Arabia over a 4-year period from 2014 to 2017. The sensitivity of the new classification for identifying severe cases was limited (65%) but higher than the old one (30%). It had a higher sensitivity for identifying patients who needed advanced healthcare compared to the old one (72% versus 32%, respectively). We propose adding decompensation of chronic diseases and thrombocytopenia-related bleeding to the category of severe dengue in the new classification. This modification improves sensitivity from 72% to 98% for identifying patients who need advanced healthcare without altering specificity (97%). It also improves sensitivity in predicting severe outcomes from 32% to 88%. In conclusion, the new classification had a low sensitivity for identifying patients needing advanced care and for predicting morbidity and mortality. We propose to include decompensation of chronic diseases and thrombocytopenia-related bleeding to the category of severe dengue in the new classification to improve the sensitivity of predicting cases requiring advanced care.

Mortality among Hospitalized Dengue Patients with Comorbidities in Mexico, Brazil, and Colombia

“…It is possible that the increased recirculation of dengue serotype 1 in 2010, after many years of relatively low circulation rates, may have increased the number of serious manifestations of the disease in the subsequent years. 34 Differences in CFRs among the three countries may reflect differing practices in the management of dengue (or experience with the illness and resultant accuracy of ICD coding), as well as differing classification of severe dengue 35 and temporal circulation of the dengue serotypes.…”

“…In addition, the databases assessed were primarily for administrative/ reimbursement purposes, and there was no independent validation or confirmation of the cases. Differences in CFRs among the three countries may reflect differing practices in the management of dengue (or experience with the illness and resultant accuracy of ICD coding), as well as differing classification of severe dengue, 35 and temporal circulation of the dengue serotypes. For all countries, the analysis was based on a combination of clinical and/or laboratory (virologically confirmed) dengue diagnoses.…”

CNS Immune Profiling in a Dengue Virus-Infected Immunocompetent Outbred ICR Mice Strain

“…Most DENV-infected people are asymptomatic or have mild symptoms, such as fever, headache, nausea, and joint pain. Unfortunately, some patients present with life-threatening warning signs, such as vascular leakage, internal bleeding, central nervous system (CNS) impairment, and multiorgan failure, that can result in death (Islam et al, 2015;Guzman et al, 2016;Ajlan et al, 2019).…”

Computational Intelligence and Statistical Learning Performances on Predicting Dengue Incidence using Remote Sensing Data

“…The classification of dengue infection as DF/DHF/DSS is based on historical cases in Thailand that infections normally occur in children younger than 15 years old [7]. At the present decade that dengue infections have extended to older age groups and spatially invade to different zones, clinical symptoms of infected patients show some variations from the WHO's descriptions [8]. Therefore, in 2009 WHO developed new criteria and guideline for dengue case diagnosis and treatment.…”

“…Therefore, in 2009 WHO developed new criteria and guideline for dengue case diagnosis and treatment. The new criteria [8] classify dengue infection into three main groups based on the ascending levels of severity as dengue without warning signs, dengue with warning signs such as abdominal pain and mucosal bleeding, and severe dengue that includes severe plasma leakage leading to shock, severe bleeding, and severe organ failure.…”