Predictors of Major Bleeding and Mortality in Dengue Infection: A Retrospective Observational Study in a Tertiary Care Centre in South India

Abstract

We conducted a retrospective observational study to describe the clinical profile and outcomes of patients admitted with a diagnosis of dengue fever in a tertiary hospital in South India. A total of 159 patients admitted from April 2014 to October 2018 were included in the study. Vomiting (70.4%), myalgia (60.4%), headache (42.1%), abdominal pain (38.4%), bleeding (38%), and rash (37.1%) were the most common symptoms at presentation. The mean duration of hospital stay was 4.9 days (SD ± 2.4), and the median cost was INR 19,708 ($285) (IQR INR 12,968–32,056 ($188–$305)). Major bleeding was associated with elevated SGOT and SGPT, severe dengue, and secondary dengue. Mortality was associated with elderly age; elevated total leukocyte count, serum bilirubin, serum creatinine, SGOT, and SGPT; and high SOFA score. In view of these observations, we recommend stratifying patients according to the WHO classification of dengue and avoiding the use of thrombocytopenia as a single marker of the severity of the illness.

C – Reactive Protein Levels in Patients Diagnosed with Dengue Fever at a Tertiary Care Hospital, Mahabubnagar

“…This correlated with the study of Udayasri et al, [3], Chakravarthi et al, [9], Gupta et al, [10], Pandya et al, [11]. Male predominance (55.65%) was seen in the present study and this correlates with majority of studies [2][3][4][5][6][7][8][9][10].…”

“…Dengue fever is a major global public health problem, especially in the tropical and subtropical countries. The burden of the disease is particularly seen in countries like India, where, during the dengue "season," the health care system is overwhelmed by patients with dengue fever [5]. The dengue disease is widely distributed in almost 35 states/UTs in India [6,7].…”

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

“…4,5 Though we observed headache as the most common symptom, other than fever, in patients with dengue, others have described vomiting. 3,4,6 This could possibly be under reporting by our patients, referral bias with patients complaining of headache being referred by the first contact doctor or a difference in the manifestation in our population. The age distribution of our cohort peaking at 21 to 30 years, is in agreement with the findings of Khan et al whose mean age of dengue fever patients was 24 years.…”

Caracterización de la plaquetopenia, leucopenia y aumento del hematocrito en la evolución y gravedad de los pacientes con diagnóstico de dengue

“…En relación con las transfusiones, únicamente fueron 5 pacientes que recibieron hemocomponentes. El promedio de días de hospitalización fue de 1,69 días, siendo el rango más común entre los 3 a 5 días, en cambio en el estudio Indu fue de 4,9 días; y si bien solo un paciente presentó dengue grave, este estudio observacional no presentó pacientes fallecidos 22 . Se debe poner de manifiesto el grupo etario joven (19 a 45 años), sobre todo el sexo femenino y la posibilidad de desarrollar un cuadro clínico con signos de alarma, que además toma en cuenta las alzas térmicas, el dolor abdominal, vomito persistente y sangrado.…”

“…En relación con la plaquetopenia, nuestro estudio reflejó un valor estadístico determinante con un valor de p=0,030, principalmente en pacientes sin signos de alarma, sin embargo, con el gráfico de dispersión la mediana estimada según el modelo binomial mostró una plaquetopenia en pacientes con signos de alarma, además mayor tendencia a la plaquetopenia en los varones. En el último estudio citado, al igual que en nuestro estudio (X=142,860/mm3), el punto de corte fue < 150,000/mm3, con 63% (p=0,001), que podría reflejar el incremento de la permeabilidad y la inflamación aún en la fase aguda 23,14 , por otro lado, en otros estudios este marcador no se relaciona con la posibilidad de sangrado y menos como predictor de la severidad, como con las transaminasas, el dengue secundario y severo, probablemente porque su disminución no es tan importante 22 .…”