Resumo

LUGO, Silvina  e  PAVLICICH, Viviana. Early Indicators of Severe Dengue in Hospitalized Patients. Pediatr. (Asunción) [online]. 2014, vol.41, n.2, pp.113-120. ISSN 1683-9803.

Introduction: Dengue is an endemic disease in tropical and subtropical countries, and a challenge to public health. Objectives: To identify the presence of predictors of severe dengue (SD) in children hospitalized for dengue with warning signs (DWS). Methodology: We conducted a nested case-control study in a cohort carried out at the emergency service of the general pediatric hospital Niños de Acosta Nu during the dengue fever epidemic of February to June 2012.Daily follow-up of patients was done with the sample ordered according to the day of disease duration until change of disease classification. Univariate analysis was done by comparison of means. Multivariate analysis was done of variables with statistical significance. Results: We included 217 children with dengue confirmed by serology.Their mean age was 11 years. No differences were found in follow-up for hematocrit ratio, WBC, or amount of fluid administered between the SD and DWS groups. Differences were found in mean platelet count for the 3rd, 4th, 5th, and 6th day of disease (p< 0.0001). Mean recorded AST was 158 ± 127 IU/L for the SD group versus 91.34 ± 73 IU/L in the DWS group (p= 0.0001), while ALT was 79.69 ± 25 IU/L in the SD group versus 51.14 ± 44 in the DWS group (p= 0.002). Albumin level differences were significant (3.2 ± 0.3 versus 2.7 ± 0.4 in the SD group [p= 0.044]), as was prothrombin time (76.7% versus 65.9% [p= 0.001]). No significant difference was found in activated partial thromboplastin time (aPTT) (35.8 sec. versus 37 sec. [p= 0.384]). Factors independently associated with severe dengue were hemoconcentration coincident with decreased platelet count (OR: 6.4 CI 95% 2.2-18.2 [p= 0.0005]), with a sensitivity of 57.9% and specificity of 90%, PPV 67.3% and NPV 85.7%, as well as   expansions received (OR: 4.8, CI 95% 1.7-13.2 [p: 0.002]) and thrombocytopenia on the 5th day of disease (OR: 6, CI 95% 2.4-14.9 [p: 0.0001]). Conclusions: In patients hospitalized for dengue with warning signs, decreased platelet count on day 5 of disease and requirement for expansions due to abdominal pain and/or early signs of shock allow identification of patients who will progress to severe dengue in the following hours.

Palavras-chave : Severe dengue; indicators; warning signs; follow up.

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