Abstract PD-016: MYOCARDIAL DEPRESSION IN PEDIATRIC DENGUE HEMORRHAGIC FEVER: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Aims & Objectives: In addition to plasma leakage, myocardial depression is thought to contribute in the pathogenesis of Dengue Hemorrhagic Fever (DHF), but its role remains unclear. We aim to compare hemodynamic parameters and myocardial inotropy among 4 grades of DHF. Methods Children (1 month – 18 years old) with DHF admitted to the emergency room (ER) or pediatric intensive care unit (PICU) were recruited between January 2016 and March 2017. Diagnosis of DHF (grade I to IV) was based on World Health Organization (WHO) criteria (2012). We excluded patient who had received fluid resuscitation or inotropes, or had congenital heart disease. Stroke volume index (SVI), Smith-Madigan Inotropy Index (SMII), Cardiac Index (CI), and Systemic Vascular Resistance Index (SVRI) was measured at first admission. Trans-jugular measurement using Ultrasonic Cardiac Output Monitor (USCOM 1A®) was performed by pediatric intensivist or trained-chief resident. Results Two hundred eight out of 230 patients were included. The SVI, CI, and SVRI were comparable among all groups (p=0.40; p=0.75; and p=0.88, respectively). However, most of grade III and IV patients had low SVI (82%), low CI (52%), and high SVRI (63%). The SMII was significantly lower in grade IV (0.96 [0.4–2.2] W/m2) than grade I (1.20 [0.7–1.8] W/m2; p<0.001), grade II (1.10 [0.9–1.8] W/m2; p=0.03), and grade III (1.10 [0.4–2.5] W/m2; p=0.005). Conclusions The most DHF grade III and IV patients were low-output and high-resistance. Myocardial depression was contributed to this condition, especially in DHF grade IV.