The association of ultrasound assessment of gallbladder wall thickness with dengue fever severity

Abstract

Objectives To evaluate the association between ultrasound assessment of gallbladder wall thickness (GBWT) among severe dengue patients and dengue patients with warning signs to their clinical outcomes. Methods A prospective, cross-sectional study involving adult dengue patients presented to our emergency department between March until September 2018. The patients were classified based on WHO classification. A gallbladder wall scan was performed on all patients. Results A total of 44 patients were enrolled into the study; majority of the patients with GBWT had severe dengue, significantly more than the dengue patients with warning signs (90.5% sensitivity; 69.6% specificity). The sensitivity of GBWT in determining admission to critical care areas or general ward was 100% with a specificity of 62.1%. Our analysis showed that the two variables significant in determining the severity of dengue were age (p = 0.045) and GBWT (p < 0.001). Both factors together gave 81.0% sensitivity and 78.3% specificity in predicting patients for severe dengue. The receiver operator characteristic curve revealed that using variable GBWT status can discriminate 87.1% (95%CI 66.3, 93.7%) of having severe dengue or dengue with warning signs. Conclusion The finding of GBWT when consolidated with other clinical parameters may assist clinicians to perform risk stratification in the emergency department and become another adjunct to the assessment of severe dengue.

Early diagnostic markers in predicting the severity of dengue disease

“…It was reported that the edema of the gall bladder is associated with the dengue hemorrhagic fever, so every dengue patient should be screened for it (Adil et al 2020). The sensitivity and specificity of the thickness of the gall bladder in assessing the admission to the intensive care unit or general ward were 100% and 62.1% (Ibrahim et al 2022). The thickening of gallbladder, which is detected radiologically, can predict the disease progression in ambulatory patients in the early stages of dengue (Gleeson et al 2022).…”

Diretrizes Clínicas da ABRAMEDE para o Manejo de Dengue em Pacientes Adultos na Emergência

“…13 Diante da falta de recomendações específicas do GRADE para definir "evidência indireta" ou distingui-la de "evidência direta", optamos por seguir a definição da Society for Desses 14 estudos incluídos, somente 7 (50%) especificamente mencionaram que pacientes da emergência haviam sido incluídos. [26][27][28]31,32,34,35 A população desses estudos foi bastante heterogênea no que se refere aos critérios de inclusão, desde pacientes com dengue confirmada sem sinais de alarme até pacientes exclusivamente internados classificados como dengue hemorrágica na classificação antiga da OMS. Essa heterogeneidade da população precluiu qualquer tipo de meta-análise ou agrupamento dos dados.…”

“…A maioria dos estudos usou o ponto de corte de 3 milímetros para definir a parede como espessada. [23][24][25]27,29 Um estudo utilizou a definição de colecistite acalculosa aguda definida por Huffman, 40 considerando ponto de corte maior que 3,5 -4 mm. 26 Nenhum estudo avaliou o método "eyeballing", isto é, avaliação da espessura da parede sem quantificação numérica da mesma.…”