Abstract
BackgroundSeries of biochemical and haematological changes occur during the course of dengue infection, which vary depending on the clinical disease. The patterns of change are not well documented and identifying these patterns in children with dengue infection would help to anticipate the progression to different clinical stages thus enabling effective management.MethodsA prospective follow up study was conducted during the period of July 2013 – April 2014 at Professorial Pediatric unit, Lady Ridgeway Hospital for Children, Colombo, Sri Lanka. Children (5–12 years) admitted within the first 84 h of fever, with a clinical diagnosis of dengue infection were recruited. Children who became positive for dengue IgM were included in the final analysis. Blood was collected on admission for complete blood count, Alanine aminotransferase, Aspartate aminotransferase, albumin, cholesterol and corrected calcium. These tests were repeated at 12 hourly intervals during the hospital stay.ResultsData of 130-subjects were analyzed (Dengue fever /Dengue hemorrhagic fever: 100/30). There was a significant difference in the pattern of white cell counts, platelets and haematocrit in the two clinical groups. Both transaminase rose initially in both dengue fever and dengue hemorrhagic fever and a steep rise were seen between 8th and 9th days in hemorrhagic fever. Both albumin and cholesterol decreased significantly at the time of entering into the critical phase. According to Receiver operating characteristic curve analysis, albumin level crossing 37.5g/L (sensitivity 86.7%, specificity 77.8%) and a 0.38 mmol/L reduction in cholesterol level (sensitivity 77.3%, specificity 71.9%) between day 3 and 4 were the best predictors of entering into critical phase. Calcium levels did not show any distinct pattern.ConclusionsThere is a clear difference in the pattern of change of both hematological and biochemical parameters in dengue fever and dengue hemorrhagic fever. Reduction in albumin and cholesterol levels seen between the completion of day 3 and day 4 were highly valid predictors of entering into critical phase in dengue hemorrhagic fever.
Highlights
Series of biochemical and haematological changes occur during the course of dengue infection, which vary depending on the clinical disease
Derangement of liver function tests characterized by mildly raised serum total bilirubin, increased alanine transaminase (ALT) and aspartate transaminase (AST), and decreased serum albumin is commonly seen in Dengue infection and can be useful as prognostic markers [7,8,9]
Children between 5 and 12 years of age, who were admitted to Professorial Pediatric unit of University of Colombo at the Lady Ridgeway Hospital for Children Colombo, within the first 84 h of onset of fever, in whom dengue infection was clinically diagnosed according to the clinical criteria (acute onset of fever and presence of two symptoms; headache/retro-orbital pain, vomiting, arthralgia/myalgia, diffuse erythematous macular rash, positive tourniquet test, leucopenia (< 5.0 × 109/L), thrombocytopenia (≤ 150 × 109/L) and rising haematocrit (> 5–10% above baseline)) described by the national guidelines published by Ministry of Health Sri Lanka, were recruited to the study [10]
Summary
Series of biochemical and haematological changes occur during the course of dengue infection, which vary depending on the clinical disease. Series of biochemical and hematological changes occur during the course of the illness They could be used to identify the complications early and introduce effective management strategies reducing morbidity and mortality. Hematological and biochemical parameters like haematocrit, albumin concentration, platelet count and aspartate aminotransferase ratio in combination is shown to be effective in identifying patients with plasma leakage in severe dengue infection [3, 4]. During the plasma leakage phase of the illness, calcium, albumin and cholesterol levels reduce in the serum [10] These three parameters could be used as early predictors of identifying the onset of the leaking phase. The pattern of biochemical changes in the early stages of the illness and their usefulness as predictors of different phases of the illness are not well known especially in Sri Lankan setting
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