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. 2014 Jul 10;8(7):e2972.
doi: 10.1371/journal.pntd.0002972. eCollection 2014 Jul.

Predictive tools for severe dengue conforming to World Health Organization 2009 criteria

Luis R Carrasco  1 , Yee Sin Leo  2 , Alex R Cook  3 , Vernon J Lee  4 , Tun L Thein  5 , Chi Jong Go  5 , David C Lye  6
Affiliations

Predictive tools for severe dengue conforming to World Health Organization 2009 criteria

Luis R Carrasco et al. PLoS Negl Trop Dis. .

Abstract

Background: Dengue causes 50 million infections per year, posing a large disease and economic burden in tropical and subtropical regions. Only a proportion of dengue cases require hospitalization, and predictive tools to triage dengue patients at greater risk of complications may optimize usage of limited healthcare resources. For severe dengue (SD), proposed by the World Health Organization (WHO) 2009 dengue guidelines, predictive tools are lacking.

Methods: We undertook a retrospective study of adult dengue patients in Tan Tock Seng Hospital, Singapore, from 2006 to 2008. Demographic, clinical and laboratory variables at presentation from dengue polymerase chain reaction-positive and serology-positive patients were used to predict the development of SD after hospitalization using generalized linear models (GLMs).

Principal findings: Predictive tools compatible with well-resourced and resource-limited settings--not requiring laboratory measurements--performed acceptably with optimism-corrected specificities of 29% and 27% respectively for 90% sensitivity. Higher risk of severe dengue (SD) was associated with female gender, lower than normal hematocrit level, abdominal distension, vomiting and fever on admission. Lower risk of SD was associated with more years of age (in a cohort with an interquartile range of 27-47 years of age), leucopenia and fever duration on admission. Among the warning signs proposed by WHO 2009, we found support for abdominal pain or tenderness and vomiting as predictors of combined forms of SD.

Conclusions: The application of these predictive tools in the clinical setting may reduce unnecessary admissions by 19% allowing the allocation of scarce public health resources to patients according to the severity of outcomes.

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Conflict of interest statement

VJL has received unrelated research grants from GlaxoSmithKline. The rest of the authors declare no conflict of interest. This does not alter our adherence to all PLOS policies on sharing data and materials.

Figures

Figure 1
Figure 1. Study inclusion criteria.
PCR: polymerase chain reaction, WHO: world health organization, DHF: dengue hemorrhagic fever, SD: severe dengue.
Figure 2
Figure 2. Comparison of the receiver operator characteristic curve in resourced and resource-limited settings for the GLM models fitted to predict SD in PCR confirmed cases (A) and PCR and serology confirmed cases (B).
See this image and copyright information in PMC

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