Clinical, haematological and radiological predictors of severe dengue in the paediatric population

Abstract

Background: Dengue is a mosquito borne viral infection which has higher morbidity and mortality in the paediatric age group than in the adult group. Objectives: To assess the clinical and haematological parameters for early diagnosis and better management of severe dengue (SD). Method: A prospective observational study was conducted in the Department of Paediatrics, FH Medical College, Agra, India from September 2021 to February 2022. Confirmed dengue cases aged 1 month to 18 years were included in the study. Cases were classified into two groups, non-severe dengue (dengue fever and dengue with warning signs) and SD. All cases had complete history, clinical examination, and relevant investigations. Bivariate analysis was performed using Chi-square test and p value <0.05 was considered significant. Results: A total of 801 confirmed cases of dengue, admitted in FH Medical College, were included in study. Of them, 564 had non-severe dengue and 237 had SD. Clinical features like gastrointestinal bleeding, lethargy, low pulse pressure, altered consciousness, ascites, bilateral pleural effusion and oliguria were significantly higher in SD as compared to non-severe dengue (p-value <0.05). Haematological parameters like severe thrombocytopenia, raised haematocrit (HCT), liver transaminase levels, deranged prothrombin time (PT) / international normalised ratio (INR), hypoalbuminaemia and radiological features like bilateral pleural effusion and ascites were significantly associated (p-value <0.05) with SD. Conclusions: In this study, clinical features like erythema, abdominal pain, vomiting, jaundice, cough, hepato-splenomegaly, severe bleeding, lethargy, low pulse pressure, altered consciousness, ascites and bilateral pleural effusion were significantly associated with SD compared to nonsevere dengue. Haematological parameters like severe thrombocytopenia, raised HCT, raised transaminase levels and deranged PT/INR and hypoalbuminaemia were also significantly associated with SD. Sri Lanka Journal of Child Health, 2023: 52(2): 188-194