Proportion and Clinical Outcome of Bleeding Manifestations in Confirmed Dengue Fever Cases – A Descriptive Longitudinal Study from Ernakulam, Kerala, India

Abstract

BACKGROUND Dengue fever is expanding in newer areas globally, with greater morbidity and mortality. We wanted to determine the proportion of bleeding manifestations among the confirmed dengue fever patients and evaluate the clinical outcomes in those with bleeding manifestations. METHODS 230 Dengue confirmed patients admitted in Government Medical College, Ernakulam from January 2018 to December 2018 were enrolled for the study. Data was recorded and entered in Microsoft Excel, and analysed using SPSS. RESULTS In the current study out of 230 subjects, bleeding manifestations were more common in 21 - 30 & 41 - 50 age groups. Out of 230 subjects, 102 had bleeding manifestations (44.3 %) like petechiae (34 %), purpura (24 %), echymosis (19.1 %), gum bleeding (17.8 %), menorrhagia (10.9 %), melena (10.4 %), conjunctival haemorrhage (9.1 %), haematuria (4.8 %), epistaxis (3.5 %), haemoptysis (2.2 %) and hematemesis (0.9 %). 86 subjects (37.4 %) received platelet transfusion on an average of 4 units. Age group, fever, previous history of dengue, IgG positivity, NS1 positivity were significantly (P < 0.0001) associated with bleeding. Most of the bleeding manifestations were significant in patients who had lower platelet counts on the first day of admission when it was less than ten thousand. CONCLUSIONS 44.3 % had bleeding manifestations with significant association between age, fever and IgG positivity. A low platelet count on admission especially less than 10,000 was significantly associated with these bleeding manifestations. These significant observations are important for both the primary care and tertiary care physicians in meticulous management and referral of dengue patients. KEY WORDS Dengue Fever, Bleeding Manifestations, Ns1 Antigen, Platelet Count.