Development of a Prognostic Prediction Model to Determine Severe Dengue in Children

Sreenivasan, Priya; Geetha, Selvaraj; Sasikala, K.

doi:10.1007/s12098-017-2591-y

Cited by 20 publications

(21 citation statements)

References 22 publications

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“…13 A recent pediatric series from our institution found clinical fluid accumulation, persistent vomiting and hematocrit ≥0.40 concurrent with platelet count <100 × 109/L prognosticative of severe dengue. 14 Wahid in his series matched our observation that an elevated ALT was predictive of DHF. 15 Lee observed that, an elevated ALT was seen in severe dengue fever but could not predict DHF or severe dengue.…”

Section: Discussionsupporting

confidence: 80%

The incidence and clinical profile of dengue hemorrhagic fever among patients diagnosed with dengue fever in a tertiary care centre in south India

Koshy¹,

Suresh

et al. 2021

Int J Res Med Sci

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Background: An understanding of factors predictive of severe forms of dengue fever would be helpful in risk stratification. The objective of the study was to determine incidence of and the factors associated with the development of dengue hemorrhagic fever (DHF) among patients admitted with dengue fever.Methods: Consenting patients were consecutively enrolled in the study and were followed forward in time to establish if they had DHF rather than milder dengue. Several factors were studied to ascertain their relation to conversion to DHF.Results: Cases included were 160 (103 males), with a mean age of 39.4 years (age range: 13-78). Fifty one (32%) developed DHF. On multivariate analysis; hepatomegaly, high alanine transaminase, low serum albumin and systolic blood pressure ≤100 mm Hg were independent predictors for the development of DHF.Conclusions: Nearly a third of patients with dengue fever develop DHF. The predictors identified, should alert the physician to this impending complication.

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Section: Discussionsupporting

confidence: 80%

The incidence and clinical profile of dengue hemorrhagic fever among patients diagnosed with dengue fever in a tertiary care centre in south India

Koshy¹,

Suresh

et al. 2021

Int J Res Med Sci

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“…The definition of vomiting was not given in most of the included studies, although two of eight studies defined vomiting as at least two episodes during the febrile phase of the illness. 25,26 For vomiting, a significant association was found in both pooled analyses (crude and adjusted estimates; figure 4; appendix p 43), and neither heterogeneity nor publication bias was found. Abdominal pain and tenderness were also consistently associated with progression to severe disease (OR 1•92 [95% CI 1•35-2•74]), although the definition was not given in all included studies and high heterogeneity was found (I²≥75%).…”

Section: Resultsmentioning

confidence: 94%

“…For clinical fluid accumulation (either pleural effusion or ascites detectable during the first 4 days of illness), four studies were included; three referred to both ascites and pleural effusion 25,26,29 and one referred to pleural effusion only. 30 Despite the small number of studies included in this analysis and little information on the method used for detecting effusion, we found a significant association between clinical fluid accumulation during the first 4 days of illness and progression to severe dengue, with low to moderate heterogeneity (I²=31%; figure 4).…”

Section: Resultsmentioning

confidence: 99%

“…Of these, only platelet count was significantly associated with progression to severe disease when measured during the febrile phase (figure 2). Of the 12 studies assessing platelet count as a predictor of disease progression that were included in the meta-analysis, two reported ORs 26,31 which were transformed and pooled with the SMDs reported in the other studies. The pooled SMD of platelet count was significantly lower among individuals who progressed to severe disease than among individuals who did not.…”

Section: Resultsmentioning

confidence: 99%

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Risk predictors of progression to severe disease during the febrile phase of dengue: a systematic review and meta-analysis

Sangkaew

Ming

Boonyasiri

et al. 2021

The Lancet Infectious Diseases

118

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Background The ability to accurately predict early progression of dengue to severe disease is crucial for patient triage and clinical management. Previous systematic reviews and meta-analyses have found significant heterogeneity in predictors of severe disease due to large variation in these factors during the time course of the illness. We aimed to identify factors associated with progression to severe dengue disease that are detectable specifically in the febrile phase.Methods We did a systematic review and meta-analysis to identify predictors identifiable during the febrile phase associated with progression to severe disease defined according to WHO criteria. Eight medical databases were searched for studies published from Jan 1, 1997, to Jan 31, 2020. Original clinical studies in English assessing the association of factors detected during the febrile phase with progression to severe dengue were selected and assessed by three reviewers, with discrepancies resolved by consensus. Meta-analyses were done using random-effects models to estimate pooled effect sizes. Only predictors reported in at least four studies were included in the meta-analyses. Heterogeneity was assessed using the Cochrane Q and I² statistics, and publication bias was assessed by Egger's test. We did subgroup analyses of studies with children and adults. The study is registered with PROSPERO, CRD42018093363.Findings Of 6643 studies identified, 150 articles were included in the systematic review, and 122 articles comprising 25 potential predictors were included in the meta-analyses. Female patients had a higher risk of severe dengue than male patients in the main analysis ( 2674[16•2%] of 16 481 vs 3052 [10•5%] of 29 142; odds ratio [OR] 1•13 [95% CI 1•01-1•26) but not in the subgroup analysis of studies with children. Pre-existing comorbidities associated with severe disease were diabetes (135 [31•3%] of 431 with vs 868 [16•0%] of 5421 without; crude OR 4•38 [2•58-7•43]), hypertension (240 [35•0%] of 685 vs 763 [20•6%] of 3695; 2•19 [1•36-3•53]), renal disease (44 [45•8%] of 96 vs 271 [16•0%] of 1690; 4•67 [2•21-9•88]), and cardiovascular disease (nine [23•1%] of 39 vs 155 [8•6%] of 1793; 2•79 [1•04-7•50]). Clinical features during the febrile phase associated with progression to severe disease were vomiting (329 [13•5%] of 2432 with vs 258 [6•8%] of 3797 without; 2•25 [1•87-2•71]), abdominal pain and tenderness (321 [17•7%] of 1814 vs 435 [8•1%] of 5357; 1•92 [1•35-2•74]), spontaneous or mucosal bleeding (147 [17•9%] of 822 vs 676 [10•8%] of 6235; 1•57 [1•13-2•19]), and the presence of clinical fluid accumulation (40 [42•1%] of 95 vs 212 [14•9%] of 1425; 4•61 [2•29-9•26]). During the first 4 days of illness, platelet count was lower (standardised mean difference -0•34 [95% CI -0•54 to -0•15]), serum albumin was lower (-0•5 [-0•86 to -0•15]), and aminotransferase concentrations were higher (aspartate aminotransferase [AST] 1•06 [0•54 to 1•57] and alanine aminotransferase [ALT] 0•73 [0•36 to 1•09]) among individuals who progressed to severe d...

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“…We define lethargy as a state of energy insufficiency affecting Activities of Daily Living (ADL). Previous studies on prediction and prognostication of DF from signs and symptoms however did not show a significant relationship between lethargy and severe DF (Thein et al, 2013;Sreenivasan et al, 2018;Joshua et al, 2016).…”

Section: Discussionmentioning

confidence: 91%

Procalcitonin and Clinical Factors Associated with Severe Dengue Infection in Hospitalized Adults in Malaysia

Sani¹,

Syazana²,

Izuan³

et al. 2019

American Journal of Infectious Diseases

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Development of a Prognostic Prediction Model to Determine Severe Dengue in Children

Abstract: Among seven WHO warning signs, predictors of severe dengue as suggested by the present multivariable prediction model include clinical fluid accumulation, persistent vomiting and hematocrit ≥0.40 concurrent with platelet count <100 × 10/L.

Cited by 20 publications

References 22 publications

The incidence and clinical profile of dengue hemorrhagic fever among patients diagnosed with dengue fever in a tertiary care centre in south India

The incidence and clinical profile of dengue hemorrhagic fever among patients diagnosed with dengue fever in a tertiary care centre in south India

Risk predictors of progression to severe disease during the febrile phase of dengue: a systematic review and meta-analysis

Procalcitonin and Clinical Factors Associated with Severe Dengue Infection in Hospitalized Adults in Malaysia

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