Indicadores tempranos de gravedad en el dengue

Abstract

To identify clinical markers of severity in dengue, different from those of major hemorrhage. Cross-sectional study. Patients with a diagnosis of dengue infection admitted to hospitals in Santander (Colombia) during the years 1993 to 1998 were studied. On admittance or during hospitalization, patients were classified as cases of dengue hemorrhagic fever (DHF) or dengue fever (DF). Clinical findings differing from those of major hemorrhage were recorded in the emergency room and during the first assessment at hospitalization. The association between these findings and the outcome of DHF were evaluated using univariate and multivariate analyses. 891 patients (DF: 420; DHF: 471) were included in the study. Associations were found between DHF and the following signs and symptoms: vomiting (OR: 1.89; 95% CI: 1.37-2.6; p = 0.0001); gingival hemorrhage (OR: 1.55; 95% CI: 1.11-2.18; p = 0.01); epistaxis (OR: 1.78; 95% CI: 1.28-2.48; p = 0.001); hepatomegaly (OR: 2.56; 95% CI: 1.61-4.07; p < 0.0001); microscopic hematuria (OR: 2.33; 95% CI: 1.36-4; p = 0.002); and rash (OR: 1.36; 95% CI: 1.04-1.77; p = 0.02). The hematocrit in the emergency room and on the first day of hospitalization was significantly higher in the group with DHF (p < 0.001, in both observations). On multivariate analysis, the hematocrit from DHF patients obtained in the emergency room was higher than that from DF, independently of the other relevant variables (difference: 3.65; 95% CI: 2.81-4.49). Under the study conditions, there was an association between early clinical findings and DHF. These results must be evaluated in a cohort study.