Disseminated intravascular coagulation initial score as a predictor of mortality in children with dengue shock syndrome: A retrospective cohort study

Abstract

BackgroundThe mortality of dengue shock syndrome (DSS) in children is still high at 12–44%. Assessment of DIC initial score using the International Society on Thrombosis and Haemostasis scoring system can help diagnosing and treating DIC, while also predicting mortality in pediatric patients with DSS. MethodsWe retrospectively collected data of children with DSS at Dr. Sardjito Hospital between January 2017 and June 2021 with inclusion criteria such as age 1 month to 18 years and laboratory parameters taken within first 24 h after DSS workup. ResultsResults showed a sample population consisting of 20 male subjects (58.8%), 24 aged >5 years (76.0%), 21 with good nutritional status (61.8%), and median length of stay 5 days (3–7), with saturation of 98% (97–99) and median pediatric Glasgow coma scale level of consciousness of 13. The laboratory profile showed median levels of hematocrit at 40.9% (32.9–44.9), thrombocytes at 20,500/L (14,000–32,000), prothrombin time of 17.8 s (14.9–25.3), fibrinogen at 123 mg/dL (106–184) and D-dimer at 832.5 ng/mL (362–1119). A DIC initial score of ≥5 25 (73.5%) resulted with a mortality of 9 children (36.0%) with a 92% survival rate in the first 6 h. The first 6-h survival according to each DIC score parameter showed 93.8%, 100%, 85.7%, and 94.1% of thrombocytes ≤50,000 μ/L, fibrinogen <100 mg/dL, D-dimer >1000 ng/mL, and prothrombin time >6 s, respectively. ConclusionA DIC initial score ≥5 can be used as a mortality predictor in the first 6 h after DSS diagnosis.