Warning sign as a predictor of dengue infection severity in children
Background: Dengue has emerged as a global public health problem, about 500,000 affected patients of 50â100 million cases will develop severe dengue infection. Therefore, early identification of severe dengue infection symptoms can save a patientâs life. The 2009 WHO dengue infection classification proposed seven warning signs to identify the risk of severe dengue. This study was conducted to predict the severity of dengue infection based on the number of warning signs.
Methods: This was a diagnostic study conducted with a retrospective analytic observation of patients admitted to Adam Malik hospital with a diagnosis of dengue infection from January 2014-May 2016. The association between warning signs and severe dengue infection was analyzed using logistic regression. We also analyzed the sensitivity, specificity, positive predictive value and negative predictive value.
Results: Of 140 patients who fulfilled the research criteria were collected from the medical records. The patients were classified as severe dengue (n=28) and nonsevere dengue (n =112). The warning signs that were associated with severe dengue were persistent vomiting (p<0.05, OR 31.9, 95%CI), fluid accumulation (p<0.05, OR 22.4, 95%CI), mucosal bleeding (p<0.05, OR 9.1, 95%CI), lethargy (p<0.05, OR 43.1, 95%CI). After analyzing the diagnostic tests, the combination of three or more warning signs showed that sensitivity of 92.9%, specificity of 78.6%, positive predictive value of 52%, negative predictive value of 97.7% was found to be associated with a severe dengue infection.
Conclusion: The combination of three or more warning signs showed a high sensitivity and specificity for predicting a severe dengue infection.
Pongpan S, Wisitwong A, Tawichasri C, Patumanond J, Namwongprom S. Development of dengue infection severity score. ISRN Pediatr. 2013;2013:845876. https://doi.org/10.1155/2013/845876
Ministry of health republic Indonesia. Profile of disease control and environmental sanitation in 2011. Jakarta : Directorate general of disease control and environmental sanitation ministry of health republic Indonesia. 2012;135-8.
Sumatera provincial health office. The Health profile of North Sumatera Province 2012. Medan: Sumatera provincial health office. 2012;38-9.
Thein TL, Gan VC, Lye DC, Yung CF, Leo YS. Utilities and limitation of the world healt organization 2009 warning sign for adult dengue severity. PLOS Negl Trop Dis. 2013;7:e2023. https://doi.org/10.1371/journal.pntd.0002023
Jayaratne SD, Atukorale V, Gomes L, Thashi C, Wijesinghe T, Fernando S, et al. Evaluation of the WHO revised criteria for classification of clinical disease severity in acute adult dengue infection. BMC Res Notes. 2012;5:645. https://doi.org/10.1186/1756-0500-5-645
Leo YS, Gan VC, Ng EL, Hao Y, Ng LC, Pok KY, et al. Utility of warning signs in guiding admission and predicting severe disease in adult dengue. BMC Infect Dis. 2013;13:498. https://doi.org/10.1186/1471-2334-13-498
Pozo-Aguilar JO, Monroy-Martinez V, Diaz D, Barrios- Palacios J, Ramos C, Ulloa-García A, et al. Evaluation of host and viral factor associated with severe dengue based on the 2009 WHO classification. Parasites Vectors. 2014;7:590. https://doi.org/10.1186/s13071-014-0590-7
Narvaez F, Gutierrez G, Perez MA, Elizondo D, Nuriez A, Balmaseda A, et al. Evaluation of the traditional and revised WHO classifications of dengue disease severity. PLoS Negl Trop Dis. 2011;5(11):e1397. https://doi.org/10.1371/journal.pntd.0001397
Ledika MA, Setiabudi D, Dhamayanti M. Association between clinical profiles and severe dengue infection in children in developing country. American Journal of Epidemiology and Infectious Disease. 2015;3(3):45-9. https://doi.org/10.12691/ajeid-3-3-1
Basuki PS, Budiyanto, Puspitasari D, Husada D, Darmowandowo W, Ismoedijanto, et al. Application of revised dengue clasification criteria as a severity marker of dengue viral infection in Indonesia. Southeast Asian J Trop Med Public Health. 2010;41(5):1088-94.
Vuong NL, Manh DH, Mai NT, Phuc LH, Luong VT, Quan VD, et al. Criteria of persistent vomitting in the WHO 2009 warning sign for dengue case classification. Trop Med Health. 2016;44:14. https://doi.org/10.1186/s41182-016-0014-9
Lee IK, Liu JW, Chen YH, Chen YC, Tsai CY, Huang SY, et al. Development of a simple clinical risk score for early prediction of severe dengue in adult patients. PLoS One. 2016;11(5):e0154772. https://doi.org/10.1371/journal.pone.0154772
Pothapregada S, Kamalakannan B, Thulasingham M. Risk factors for shock in children with dengue fever. Indian J Crit Care Med. 2015;19(11):661-4. https://doi.org/10.4103/0972-5229.169340
Rigau-Pérez JG, Laufer MK. Dengue-related deaths in Puerto Rico, 1992-1996: diagnosis and clinical alarm signals. Clin Infect Dis. 2006;42(9):1241-6. https://doi.org/10.1086/501355
Leo YS, Thein TL, Fisher DA, Low JG, Oh HM, Narayanan RL, et al. Confirmed adult dengue deaths in singapore: 5 years multi center retrospective study. BMC Infect Dis. 2011;11:123. https://doi.org/10.1186/1471-2334-11-123
Woon YL, Hor CP, Hussin N, Zakaria A, Goh PP, Cheah WK. A two year review on epidemiology and clinical characteristic of dengue deaths in Malaysia, 2013-2014. PLoS Negl Trop Dis. 2016;10(5):e0004575. https://doi.org/10.1371/journal.pntd.0004575
Carrasco LR, Leo YS, Cook AR, Lee VJ, Thein TL, Go CJ, et al. Predictive tools for severe dengue conforming to world health organization 2009 criteria. Plos Negl Trop Dis. 2014;8(7):e2972. https://doi.org/10.1371/journal.pntd.0002972
Carlos CC, Oishi K, Cinco MT, Mapua CA, Inoue S, Cruz DJ, et al. Comparison of clinical features and hematologic abnormalities between dengue fever and dengue hemorrhagic fever among children in the Philippines. Am J Trop Med Hyg. 2005;73(2):435-40.
Hadinegoro SR. The revised WHO dengue case classification: does the system need to be modified? Paediatr Int Child Health. 2012;32(1):33-8. https://doi.org/10.1179/2046904712Z.00000000052
de Andrade SM, Herkert CM, de Cunha RV, Rodrigues MD, da Silva BA. A new approach to reducing mortality from dengue. Open Journal of Clinical Diagnostics. 2014;4:12-6. https://doi.org/10.4236/ojcd.2014.41003
Alexander N, Balmaseda A, Coelho IC, Dimaano E, Hien TT, Hung NT, et al. Multicentre prospective study on dengue classification in four South-east Asian and three Latin American countries. Trop Med Int Health. 2011; 16(8):936-48. https://doi.org/10.1111/j.1365-3156.2011.02793.x
Win MM, Phumratanaprapin W, Phonrat B, Dhitavat J, Sutherat M, Luvira V, et al. Warning signs to predict severe dengue in adult patients at hospital for tropical diseases Thailand. In: Faculty of Tropical Medicine Mahidol University, Editors. Tropical disease post 2015: New threats or towards sustainable success. Bangkok: Faculty of Tropical Medicine Mahidol University, 2015.p.81.
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