The value of daily platelet counts for predicting dengue shock syndrome: Results from a prospective observational study of 2301 Vietnamese children with dengue

Abstract

BackgroundDengue is the most important mosquito-borne viral infection to affect humans. Although it usually manifests as a self-limited febrile illness, complications may occur as the fever subsides. A systemic vascular leak syndrome that sometimes progresses to life-threatening hypovolaemic shock is the most serious complication seen in children, typically accompanied by haemoconcentration and thrombocytopenia. Robust evidence on risk factors, especially features present early in the illness course, for progression to dengue shock syndrome (DSS) is lacking. Moreover, the potential value of incorporating serial haematocrit and platelet measurements in prediction models has never been assessed.Methodology/Principal findingsWe analyzed data from a prospective observational study of Vietnamese children aged 5–15 years admitted with clinically suspected dengue to the Hospital for Tropical Diseases in Ho Chi Minh City between 2001 and 2009. The analysis population comprised all children with laboratory-confirmed dengue enrolled between days 1–4 of illness. Logistic regression was the main statistical model for all univariate and multivariable analyses. The prognostic value of daily haematocrit levels and platelet counts were assessed using graphs and separate regression models fitted on each day of illness. Among the 2301 children included in the analysis, 143 (6%) progressed to DSS. Significant baseline risk factors for DSS included a history of vomiting, higher temperature, a palpable liver, and a lower platelet count. Prediction models that included serial daily platelet counts demonstrated better ability to discriminate patients who developed DSS from others, than models based on enrolment information only. However inclusion of daily haematocrit values did not improve prediction of DSS.Conclusions/SignificanceDaily monitoring of platelet counts is important to help identify patients at high risk of DSS. Development of dynamic prediction models that incorporate signs, symptoms, and daily laboratory measurements, could improve DSS prediction and thereby reduce the burden on health services in endemic areas.

Platelet count and AST can reliably predict the onset of plasma leakage in dengue, a low-cost triage tool during epidemics

“…Suwarto et al reported an AUC of 0.83 with sensitivity of 72.3% and specificity of 76.1% for predicting DHF at platelet count of 49,500/cumm (19). Lam et al have validated a similar model utilizing daily platelet counts for use among the pediatric patients (20). The implication of our finding necessitates performing daily full blood counts.…”

Diagnostic accuracy and predictive value in differentiating the severity of dengue infection

“…A total of 26 included studies conducted between 1994 and 2017 were published between 2008 and 2018 . However, two studies were related, leaving a total of 25 studies of different settings .…”

“…All studies evaluated the models against SD and non‐SD as reference standard except two which evaluated against DSS and WS with hospitalisation . The DSS classification is a subcategory of SD under the WHO 2009 classification (Table ).…”

Thrombocytopenia and Platelet Dysfunction in Acute Tropical Infectious Diseases

“…While many studies have investigated the abnormalities of platelet numbers in tropical infections and its applicability in clinical care, for example, as a diagnostic marker or monitoring of disease severity, [10][11][12][13] only few data are available on acquired platelet function abnormalities in these infections. This is an important research gap as infection-induced changes in the function of platelets may equally be important for disease pathophysiology as absolute changes in platelet counts.…”