Risk factors of dengue shock syndrome in children

Abstract

Background: Dengue shock syndrome (DSS) is a major public health problem with high morbidity and mortality, especially in a case of prolonged shock with subsequently massive bleeding. The morbidity and mortality from DSS can be decreased by early diagnosis of shock and adequate replacement of plasma loss. Therefore, determination of risk factors of DSS is crucial for early detection and proper management of shock.

Objective: To determine the risk factors of dengue shock syndrome in children.

Material and method: Medical records of 110 patients with dengue hemorrhagic fever (DHF) and 55 with DSS admitted at BMA Medical College and Vajira Hospital between January 2003 and December 2005 were collected by simple random sampling. Clinical data including age, sex, signs and symptoms, and laboratory data (before defervescence) of patients with DHF and DSS were comparatively analyzed. Risk factors of DSS were determined by Mantel-Haenzel test, simple and multiple logistic regression analysis.

Results: Of the 165 children, 110 were in the DHF group (grade I, 72 children; grade II, 38 children) and 55 were in the DSS group (grade III, 53 children; grade IV, 2 children). The age, sex, nutritional status, and duration of fever between both groups were not statistically different. Risk factors of DSS were bleeding, secondary dengue infection, and hemoconcentration of more than 22%from baseline hematocrit (adjusted OR (95% CI): 5.1 (1.5-17.1), 21.8 (5.3-90.8), 15.5 (4.4-54.6), respectively).

Conclusion: Risk factors of DSS are bleeding, secondary dengue infection, and hemoconcentration of more than 22%. Patients with DHF who have one of these risk factors should be closely observed for early signs of shock, as prompt and adequate fluid replacement can prevent the progression of shock.