Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 May 5;4(2):ofx056.
doi: 10.1093/ofid/ofx056. eCollection 2017 Spring.

Predictors of Dengue-Related Mortality and Disease Severity in a Tertiary Care Center in North India

Siddharth Jain  1 , Abhenil Mittal  1 , Surendra Kumar Sharma  1 , Ashish Datt Upadhyay  2 , Ravindra Mohan Pandey  2 , Sanjeev Sinha  1 , Manish Soneja  1 , Ashutosh Biswas  1 , Ranveer Singh Jadon  1 , Mahadeo B Kakade  3 , Cecilia Dayaraj  3
Affiliations

Predictors of Dengue-Related Mortality and Disease Severity in a Tertiary Care Center in North India

Siddharth Jain et al. Open Forum Infect Dis. .

Abstract

Background: There is lack of reliable predictors of disease severity and mortality in dengue. The present study was carried out to identify these predictors during the 2015 outbreak in India.

Methods: This prospective observational study included confirmed adult dengue patients hospitalized between August and November 2015 in a tertiary care centre in New Delhi, India. Appropriate statistical tests were used to compare clinicolaboratory characteristics, derive predictors of severe disease and mortality, and compute a predictive score for mortality. Serotyping was done.

Results: Data of 369 patients were analyzed (mean age, 30.9 years; 67% males). Of these, 198 (54%) patients had dengue fever, 125 (34%) had dengue hemorrhagic fever (grade 1 or 2), and 46 (12%) developed dengue shock syndrome (DSS). Twenty-two (6%) patients died. Late presentation to the hospital (≥5 days after onset) and dyspnea at rest were identified as independent predictors of severe disease. Age ≥24 years, dyspnea at rest and altered sensorium were identified as independent predictors of mortality. A clinical risk score was developed (12*age + 14*sensorium + 10*dyspnea), which, if ≥22, predicted mortality with a high sensitivity (81.8%) and specificity (79.2%). The predominant serotypes in Delhi (2015) were dengue virus DENV2 and DENV4.

Conclusion: Age ≥24 years, dyspnea at rest, and altered sensorium were identified as independent predictors of mortality. Platelet counts did not determine outcome in dengue patients. Timely referral/access to healthcare is important. The clinical risk score for mortality prediction that was developed in this study can be used in all healthcare settings, after validation in larger cohorts.

Keywords: dengue shock; mortality; outbreak; predictors; severity..

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Receiver operating characteristics (ROC) curve for the derived predictive score for mortality in dengue shock syndrome patients. Area under the curve = 84.7%.
See this image and copyright information in PMC

References

    1. World Health Organization. Dengue and severe dengue. Fact Sheet No. 117. Updated April 2016 Available at: http://www.who.int/mediacentre/factsheets/fs117/en/ Accessed 18 July 2016.
    1. Bhatt S, Gething PW, Brady OJ, et al. The global distribution and burden of dengue. Nature 2013; 496:504–7. - PMC - PubMed
    1. Moore C. UTMB Galveston researchers discover first new dengue feverserotype in 50-years. BIONews Texas 2013. Available at: https://bionews-tx.com/news/2013/10/25/utmb-galveston-researchers-discov.... Accessed 14 February 2017 https://bionews-tx.com/news/2013/10/25/utmb-galveston-researchers-discov... .
    1. Flipse J, Diosa-Toro MA, Hoornweg TE, et al. Antibody-dependent enhancement of dengue virus infection in primary human macrophages; balancing higher fusion against antiviral responses. Sci Rep 2016; 6:29201. - PMC - PubMed
    1. World Health Organization. Dengue Haemorrhagic Fever: Diagnosis, Treatment, Prevention and Control. 2nd ed Geneva: World Health Organization, 1997.