Abstract
Dengue mortality remains high despite monitoring against warning signs (WS). The associations of WS at febrile phase (FP) and hemorrhage at defervescence with the levels and kinetics of ROTEM, platelet count, cortisol, and ferritin were analyzed. Patients with confirmed dengue serology and WS in two centers were screened (n = 275) and 62 eligible patients were recruited prospectively over 9 months. “Vomiting” was the commonest WS (62.9%), with shortened clotting time (CT) INTEM (p = 0.01). “Hematocrit increase” showed significant prolonged CT INTEM, EXTEM, and FIBTEM (p < 0.05). “Platelet decrease” showed reduced platelet function and reduced clot amplitude at 10 min (A10) and maximum clot firmness (MCF) in INTEM and EXTEM (p < 0.001). The kinetics were reduced in platelet count, CT EXTEM, and cortisol (p < 0.05) but increased in CT INTEM (p = 0.03). At FP, “vomiting”, “hematocrit increase”, and “platelet decrease” demonstrated impaired CT, clot strengths A10/MCF and platelet functions. Majority (60/62, 96.7%) had non-severe outcomes, consistent with increase in cortisol kinetics. In conclusion, “vomiting”, “hematocrit increase” and “platelet decrease” at FP correlated with ROTEM. No conclusion could be made further regarding ferritin and cortisol. Larger study is required to study “hematocrit increase” with ROTEM as a potential marker for hemorrhage.
Highlights
Dengue mortality is a public health concern
Patients in TP-1 were re-assessed upon recognition of severe dengue, or at 48 h later if there was no progression into severe dengue (TP-2) for hemodynamic, clinical, and hemorrhage complications/Grade ≥2 Common Terminology Criteria for Adverse Events (CTCAE) [16]
Febrile phase was chosen as the baseline time-point (TP-1) to measure disease kinetics
Summary
Dengue mortality is a public health concern. Overall, 40% of world population live in dengue transmission areas [1]. Concerns have arisen that the warning signs definitions were perhaps too broad and were largely based on expert opinions rather than well-designed clinical trials [7]. Conventional coagulation tests such as prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (APTT) are primarily used clinically for anticoagulant drug monitoring. We analyzed the associations of hemorrhagic complications with ROTEM (INTEM, EXTEM, and FIBTEM (fibrin-based thromboelastometry test)), and the kinetics of ROTEM and biochemical markers such as ferritin and cortisol during progression from febrile phase into defervescence
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: International Journal of Environmental Research and Public Health
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
