Development of Dengue Infection Severity Score

Abstract

Objectives. To develop a simple scoring system to predict dengue infection severity based on patient characteristics and routine clinical profiles. Methods. Retrospective data of children with dengue infection from 3 general hospitals in Thailand were reviewed. Dengue infection was categorized into 3 severity levels: dengue infection (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). Coefficients of significant predictors of disease severity under ordinal regression analysis were transformed into item scores. Total scores were used to classify patients into 3 severity levels. Results. Significant clinical predictors of dengue infection severity were age >6 years, hepatomegaly, hematocrit ≥40%, systolic pressure <90 mmHg, white cell count >5000 /μL, and platelet ≤50000 /μL. The derived total scores, which ranged from 0 to 18, classified patients into 3 severity levels: DF (scores <2.5, n = 451, 58.1%), DHF (scores 2.5–11.5, n = 276, 35.5%), and DSS (scores >11.5, n = 50, 6.4%). The derived score correctly classified patients into their original severity levels in 60.7%. An under-estimation of 25.7% and an over-estimation of 13.5% were clinically acceptable. Conclusions. The derived dengue infection severity score classified patients into DF, DHF, or DSS, correctly into their original severity levels. Validation of the score should be reconfirmed before application of routine practice.

The total leucocyte count: its utility in dengue

“…23,24 A few studies had a lower and others, a higher proportion of cases with leucopenia. 1,2,4,15,16,18,25 A normal leucocyte count was observed in 55% of cases in our study in concordance with few studies but it was lower and higher in other studies. 2,4,15,18,21,24 Leucocytosis was noted in 9% of cases in our study in concordance with few studies.…”

“…2,4,15,18,21,24 Leucocytosis was noted in 9% of cases in our study in concordance with few studies. 25 It was seen in lower and higher proportion of cases in other studies. 15,18,21 A demographic assessment of leucopenia revealed an equal distribution of cases across the ages and both sexes.…”

“…29 Thus, our study in association with serology suggests that leucopenia is an early marker of dengue and association of leucopenia with thrombocytopenia suggests that it could be one of the prognosticator of severe dengue. 17,21,22,25 Limitations of study-Our study is limited by …”

“…7,17,18,20,25 Neutropenia is also attributed to marked degeneration of mature neutrophils in febrile phase with shift to left. 21 Stress accompanied with shock may be the cause of mild initial leukocytosis.…”

The Value of DNS1 Antigen for Early Detection of Dengue Infection in Children: The Changing Sensitivity

“…In a study by Mishra S. [15] , various laboratory parameters were measured to identify the severity. Surangrat who worked on scoring systems, gives points to find out severity [16] . Symptoms and signs alone were used in a meta analysis by H. Zhang [17] for prediction of severe dengue disease.…”