Factors Predicting Severe Dengue in Children within 72 Hours of Illness Onset

Background: Dengue fever (DF) is the most rapidly spreading mosquito-borne viral disease in the world. In the epidemic zones, dengue is a leading cause of hospitalization and death in children. The World Health Organization (WHO) has identified warning signs for cases likely to deteriorate, but these signs and symptoms often appear after 72 hours. Thus, this study was conducted to identify a group of patients at risk of severe dengue disease in the early 72-hour period, helping doctors give indications for hospital admission and closely monitor for early detection of severe complications for timely treatment. Objective: To determine factors predicting severe dengue in children within 72 hours of illness onset in an outpatient setting. Methods: Prospective cohort studies were conducted from June 2012 to December 2014 at Tien Giang Central General Hospital. Results: Of 1,039 cases of children with clinically suspected dengue who qualified for inclusion in the analysis, 283 patients were laboratory-confirmed dengue by one of the composite gold standards, including RT-PCR, NS1 ELISA or IgM seroconversion in the convalescent blood samples. There were 13 severe dengue cases with shock syndrome, severe bleeding, and respiratory distress. Early factors predicting severe dengue within 72 hours of illness onset were as follows: high hematocrit, platelet count ≤100.000/mm³, albumin level ≤40 g/l, AST≥80 U/L, ALT≥40 U/L at enrolment and DENV-2 infection. Conclusions: Severe dengue can lead to death in dengue children patients. If, within 72 hours of illness onset, children with dengue have high hematocrit, platelet count ≤100.000/mm³, albumin level ≤40 g/l, AST≥80 U/L, ALT≥40 U/L at enrolment and DENV-2 infection, clinical doctors, especially doctors in primary settings, should ensure timely diagnosis and treatment, as well as closely monitor this patient group who are at risk to develop severe dengue within the next days.Background: Dengue fever (DF) is the most rapidly spreading mosquito-borne viral disease in the world. In the epidemic zones, dengue is a leading cause of hospitalization and death in children. The World Health Organization (WHO) has identified warning signs for cases likely to deteriorate, but these signs and symptoms often appear after 72 hours. Thus, this study was conducted to identify a group of patients at risk of severe dengue disease in the early 72-hour period, helping doctors give indications for hospital admission and closely monitor for early detection of severe complications for timely treatment. Objective: To determine factors predicting severe dengue in children within 72 hours of illness onset in an outpatient setting. Methods: Prospective cohort studies were conducted from June 2012 to December 2014 at Tien Giang Central General Hospital. Results: Of 1,039 cases of children with clinically suspected dengue who qualified for inclusion in the analysis, 283 patients were laboratory-confirmed dengue by one of the composite gold standards, including RT-PCR, NS1 ELISA or IgM seroconversion in the convalescent blood samples. There were 13 severe dengue cases with shock syndrome, severe bleeding, and respiratory distress. Early factors predicting severe dengue within 72 hours of illness onset were as follows: high hematocrit, platelet count ≤100.000/mm³, albumin level ≤40 g/l, AST≥80 U/L, ALT≥40 U/L at enrolment and DENV-2 infection. Conclusions: Severe dengue can lead to death in dengue children patients. If, within 72 hours of illness onset, children with dengue have high hematocrit, platelet count ≤100.000/mm³, albumin level ≤40 g/l, AST≥80 U/L, ALT≥40 U/L at enrolment and DENV-2 infection, clinical doctors, especially doctors in primary settings, should ensure timely diagnosis and treatment, as well as closely monitor this patient group who are at risk to develop severe dengue within the next days.