Dengue score: a proposed diagnostic predictor for pleural effusion and/or ascites in adults with dengue infection

Suhendro Suwarto, Leonard Nainggolan, Robert Sinto, Bonita Effendi, Eppy Ibrahim, Maulana Suryamin, R Tedjo Sasmono, Suhendro Suwarto, Leonard Nainggolan, Robert Sinto, Bonita Effendi, Eppy Ibrahim, Maulana Suryamin, R Tedjo Sasmono

Abstract

Background: There are several limitations in diagnosing plasma leakage using the World Health Organization (WHO) guidelines of dengue hemorrhagic fever. We conducted a study to develop a dengue scoring system to predict pleural effusion and/or ascites using routine laboratory parameters.

Methods: A prospective observational study was carried out at Cipto Mangunkusumo Hospital and Persahabatan Hospital, Jakarta, Indonesia. Dengue-infected adults admitted on the third febrile day from March, 2010 through August, 2015 were included in the study. A multivariate analysis was conducted to determine the independent diagnostic predictors of pleural effusion and/or ascites and to convert the prediction model into a scoring system.

Results: A total of 172 dengue-infected adults were enrolled in the study. Of the 172 patients, 101 (58.7 %) developed pleural effusion and/or ascites. A multivariate analysis was conducted to determine the independent diagnostic predictors of pleural effusion and/or ascites in dengue-infected adults. The predictors were scored based on the following calculations: hemoconcentration ≥15.1 % had a score of 1 (OR, 3.11; 95 % CI, 1.41-6.88), lowest albumin concentration at critical phase ≤3.49 mg/dL had a score of 1 (OR, 4.48; 95 % CI, 1.87-10.77), lowest platelet count ≤49,500/μL had a score of 1 (OR, 3.62; 95 % CI, 1.55-8.49), and elevated ratio of AST ≥2.51 had a score of 1 (OR 2.67; 95 % CI, 1.19-5.97). At a cut off of ≥ 2, the Dengue Score predicted pleural effusion and/or ascites diagnosis with positive predictive value of 79.21 % and negative predictive value of 74.63 %. This prediction model is suitable for calibration and good discrimination.

Conclusions: We have developed a Dengue Score that could be used to identify pleural effusion and/or ascites and might be useful to stratify dengue-infected patients at risk for developing severe dengue.

Keywords: AST ratio; Albumin; Ascites; Dengue score; Hematocrit; Platelet; Pleural effusion.

Figures

Fig. 1
Fig. 1
Formulae for calculating the degrees of hemoconcentration, albuminemia, and the ratios of AST and ALT
Fig. 2
Fig. 2
Comparison of area receiver operating characteristic (AROC) curves between the logistic regression model and Dengue Score

References

    1. Srikiatkhachorn A, Green S. Markers of dengue disease severity. Curr Top Microbiol Immunol. 2010;338:67–82.
    1. WHO-SEARO . Comprehensive guidelines for prevention and control of dengue and dengue haemorrhagic fever. Revised and expanded. New Delhi: World Health Organization; 2011.
    1. Karyanti MR, Uiterwaal CSPM, Kusriastuti R, Hadinegoro SR, Rovers MM, Heesterbeek H, et al. The changing incidence of dengue haemorrhagic fever in Indonesia: a 45-year registry-based analysis. BMC Infect Dis. 2014;14:412. doi: 10.1186/1471-2334-14-412.
    1. Leo Y-S, Gan VC, Ng E-L, Hao Y, Ng L-C, Pok K-Y, et al. Utility of warning signs in guiding admission and predicting severe disease in adult dengue. BMC Infect Dis. 2013;13:498. doi: 10.1186/1471-2334-13-498.
    1. TDR/WHO . Dengue: guidelines for diagnosis, treatment, prevention and control. Geneva: World Health Organization; 2009.
    1. Fujimoto DE, Koifman S. Clinical and laboratory characteristics of patients with dengue hemorrhagic fever manifestations and their transfusion profile. Rev Bras Hematol E Hemoter. 2014;36:115–20. doi: 10.5581/1516-8484.20140027.
    1. Chairulfatah A, Setiabudi D, Agoes R, Colebunders R. Thrombocytopenia and platelet transfusions in dengue haemorrhagic fever and dengue shock syndrome. WHO Dengue Bull. 2003;27:138–43.
    1. Bandyopadhyay S, Lum LCS, Kroeger A. Classifying dengue: a review of the difficulties in using the WHO case classification for dengue haemorrhagic fever. Trop Med Int Health TM IH. 2006;11:1238–55. doi: 10.1111/j.1365-3156.2006.01678.x.
    1. Ng CFS, Lum LCS, Ismail NA, Tan LH, Tan CPL. Clinicians’ diagnostic practice of dengue infections. J. Clin. Virol. Off. Publ. Pan Am. Soc. Clin. Virol. 2007;40:202–6. doi: 10.1016/j.jcv.2007.08.017.
    1. WHO . Dengue haemorrhagic fever: diagnosis, treatment, prevention and control. Geneva: World Health Organization; 1997.
    1. Jagadishkumar K, Jain P, Manjunath VG, Umesh L. Hepatic involvement in dengue fever in children. Iran J Pediatr. 2012;22:231–6.
    1. Itha S, Kashyap R, Krishnani N, Saraswat VA, Choudhuri G, Aggarwal R. Profile of liver involvement in dengue virus infection. Natl Med J India. 2005;18:127–30.
    1. Roy A, Sarkar D, Chakraborty S, Chaudhuri J, Ghosh P, Chakraborty S. Profile of hepatic involvement by dengue virus in dengue infected children. North Am J Med Sci. 2013;5:480–5. doi: 10.4103/1947-2714.117313.
    1. Karoli R, Fatima J, Siddiqi Z, Kazmi KI, Sultania AR. Clinical profile of dengue infection at a teaching hospital in North India. J Infect Dev Ctries. 2012;6:551–4. doi: 10.3855/jidc.2010.
    1. Michels M, Sumardi U, de Mast Q, Jusuf H, Puspita M, Dewi IMW, et al. The predictive diagnostic value of serial daily bedside ultrasonography for severe dengue in Indonesian adults. PLoS Negl Trop Dis. 2013;7:e2277. doi: 10.1371/journal.pntd.0002277.
    1. Balasubramanian S, Janakiraman L, Kumar SS, Muralinath S, Shivbalan S. A reappraisal of the criteria to diagnose plasma leakage in dengue hemorrhagic fever. Indian Pediatr. 2006;43:334–9.
    1. Srikiatkhachorn A, Gibbons RV, Green S, Libraty DH, Thomas SJ, Endy TP, et al. Dengue hemorrhagic fever: the sensitivity and specificity of the world health organization definition for identification of severe cases of dengue in Thailand, 1994–2005. Clin Infect Dis Off Publ Infect Dis Soc Am. 2010;50:1135–43. doi: 10.1086/651268.
    1. Motla M, Manaktala S, Gupta V, Aggarwal M, Bhoi SK, Aggarwal P, et al. Sonographic evidence of ascites, pleura-pericardial effusion and gallbladder wall edema for dengue fever. Prehospital Disaster Med. 2011;26:335–41. doi: 10.1017/S1049023X11006637.
    1. Potts JA, Thomas SJ, Srikiatkhachorn A, Supradish P, Li W, Nisalak A, et al. Classification of dengue illness based on readily available laboratory data. Am J Trop Med Hyg. 2010;83:781–8. doi: 10.4269/ajtmh.2010.10-0135.
    1. Tan S-S, Bujang MA. The clinical features and outcomes of acute liver failure associated with dengue infection in adults: a case series. Braz J Infect Dis Off Publ Braz Soc Infect Dis. 2013;17:164–9.
    1. Lee LK, Gan VC, Lee VJ, Tan AS, Leo YS, Lye DC. Clinical relevance and discriminatory value of elevated liver aminotransferase levels for dengue severity. PLoS Negl Trop Dis. 2012;6:e1676. doi: 10.1371/journal.pntd.0001676.
    1. Lanciotti RS, Calisher CH, Gubler DJ, Chang GJ, Vorndam AV. Rapid detection and typing of dengue viruses from clinical samples by using reverse transcriptase-polymerase chain reaction. J Clin Microbiol. 1992;30:545–51.
    1. Sasmono RT, Aryati A, Wardhani P, Yohan B, Trimarsanto H, Fahri S, et al. Performance of Simplexa dengue molecular assay compared to conventional and SYBR green RT-PCR for detection of dengue infection in Indonesia. PLoS One. 2014;9:e103815. doi: 10.1371/journal.pone.0103815.
    1. Kalayanarooj S, Vaughn DW, Nimmannitya S, Green S, Suntayakorn S, Kunentrasai N, et al. Early clinical and laboratory indicators of acute dengue illness. J Infect Dis. 1997;176:313–21. doi: 10.1086/514047.
    1. Nikolsky E, Mehran R, Dangas G, Fahy M, Na Y, Pocock SJ, et al. Development and validation of a prognostic risk score for major bleeding in patients undergoing percutaneous coronary intervention via the femoral approach. Eur Heart J. 2007;28:1936–45. doi: 10.1093/eurheartj/ehm194.
    1. Lesmana CRA, Pakasi LS, Inggriani S, Aidawati ML, Lesmana LA. Development of non-alcoholic fatty liver disease scoring system among adult medical check-up patients: a large cross-sectional and prospective validation study. Diabetes Metab Syndr Obes Targets Ther. 2015;8:213–8. doi: 10.2147/DMSO.S80364.
    1. Lipsky BA, Weigelt JA, Sun X, Johannes RS, Derby KG, Tabak YP. Developing and validating a risk score for lower-extremity amputation in patients hospitalized for a diabetic foot infection. Diabetes Care. 2011;34:1695–700. doi: 10.2337/dc11-0331.
    1. Kalayanarooj S. Dengue classification: current WHO vs. the newly suggested classification for better clinical application? J Med Assoc Thail Chotmaihet Thangphaet. 2011;94(3):S74–84.
    1. Wills BA, Oragui EE, Stephens AC, Daramola OA, Dung NM, Loan HT, et al. Coagulation abnormalities in dengue hemorrhagic fever: serial investigations in 167 vietnamese children with dengue shock syndrome. Clin Infect Dis Off Publ Infect Dis Soc Am. 2002;35:277–85. doi: 10.1086/341410.
    1. Gunsilius E, Petzer A, Stockhammer G, Nussbaumer W, Schumacher P, Clausen J, et al. Thrombocytes are the major source for soluble vascular endothelial growth factor in peripheral blood. Oncology. 2000;58:169–74. doi: 10.1159/000012095.
    1. Olsson A-K, Dimberg A, Kreuger J, Claesson-Welsh L. VEGF receptor signalling - in control of vascular function. Nat Rev Mol Cell Biol. 2006;7:359–71. doi: 10.1038/nrm1911.
    1. Souza LJ de, Alves JG, Nogueira RMR, Gicovate Neto C, Bastos DA, Siqueira EW da S, et al. Aminotransferase changes and acute hepatitis in patients with dengue fever: analysis of 1,585 cases. Braz J Infect Dis Off Publ Braz Soc Infect Dis. 2004;8:156–63.
    1. Samanta J, Sharma V. Dengue and its effects on liver. World J Clin Cases. 2015;3:125–31. doi: 10.12998/wjcc.v3.i2.125.
    1. Mahmuduzzaman M, Chowdhury AS, Ghosh DK, Kabir IM, Rahman MA, Ali MS. Serum transaminase level changes in dengue fever and its correlation with disease severity. Mymensingh Med J MMJ. 2011;20:349–55.
    1. Seneviratne SL, Malavige GN, de Silva HJ. Pathogenesis of liver involvement during dengue viral infections. Trans R Soc Trop Med Hyg. 2006;100:608–14. doi: 10.1016/j.trstmh.2005.10.007.
    1. Carobene A, Braga F, Roraas T, Sandberg S, Bartlett WA. A systematic review of data on biological variation for alanine aminotransferase, aspartate aminotransferase and γ-glutamyl transferase. Clin Chem Lab Med. 2013;51:1997–2007. doi: 10.1515/cclm-2013-0096.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere