Predictive Symptoms and Signs of Severe Dengue Disease for Patients with Dengue Fever: A Meta-Analysis

Abstract

The aim of the meta-analysis was to provide more solid evidence for the reliability of the new classification. A systematic literature search was performed using PubMed, Armed Forces Pest Management Board Literature Retrieval System, and Google Scholar up to August 2012. A pooled odds ratio (OR) was calculated using either a random-effect or a fixed-effect model. A total of 16 papers were identified. Among the 11 factors studied, five symptoms demonstrated an increased risk for SDD, including bleeding [OR: 13.617; 95% confidence interval (CI): 3.281, 56.508], vomiting/nausea (OR: 1.692; 95% CI: 1.256, 2.280), abdominal pain (OR: 2.278; 95% CI: 1.631, 3.182), skin rashes (OR: 2.031; 95% CI: 1.269, 3.250), and hepatomegaly (OR: 4.751; 95% CI: 1.769, 12.570). Among the four bleeding-related symptoms including hematemesis, melena, gum bleeding, and epistaxis, only hematemesis (OR: 6.174; 95% CI: 2.66, 14.334; P < 0.001) and melena (OR: 10.351; 95% CI: 3.065, 34.956; P < 0.001) were significantly associated with SDD. No significant associations with SDD were found for gender, lethargy, retroorbital pain, diarrhea, or tourniquet test, whereas headache appeared protective (OR: 0.555; 95% CI: 0.455, 0.676). The meta-analysis suggests that bleeding (hematemesis/melena), vomiting/nausea, abdominal pain, skin rashes, and hepatomegaly may predict the development of SDD in patients with DF, while headache may predict otherwise.

Comparison of vomiting and diarrhoea frequency among dengue-infected patients

“…Hematemesis on Day 1 and Day 3 of illness might be a predictor of severe dengue. This is evident in previous study where hematemesis has an odds ratio of 6.174 (95% CI: 2.660, 14.334) for predicting severe dengue [15]. Other common sites of mucosal bleeding were the gum and menorrhagia but it is unlikely to be predictable since much of the dengue with warning signs did not progress to severe dengue.…”

“…Unfortunately, this will increase the health care burden since majority of the patients with warning signs would not develop complication and only 5% of all dengue-infected cases would progress to severe dengue [13]. A metaanalysis indicated that vomiting was able to predict the progression towards severe dengue [15]. However, the study did not take the day of illness into account when the symptom occurred in their metaanalysis [15].…”

“…A metaanalysis indicated that vomiting was able to predict the progression towards severe dengue [15]. However, the study did not take the day of illness into account when the symptom occurred in their metaanalysis [15]. Ideally, the meta-analysis should be stratified according to the day of illness so that it could allow appropriate prediction of the disease outcome.…”

“…This could be explained by the different underlying population which manifests symptoms differently or by clinical practice variation with different emphasis on the warning signs in their studies [7,11,17]. In fact, metaanalysis indicated that abdominal pain was a better predictor than vomiting with odds ratio of 2.278 (95% CI: 1.631, 3.182) compared to vomiting with odds ratio of 1.692 (95% CI: 1.256, 2.280) [15].…”

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

“…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. So to predict the severity of infection, positive serological NS1 antigen test along with the clinical symptoms and signs is the probable simple method [18] .…”