Abstract
Background: There are many tropical areas where dengue is a significant mosquito borne disease and causes substantial global mortality. Despite the high burden of dengue virus (DENV) infections, severe dengue remains fatal in Bangladesh. Nevertheless, few risk factors are known for death in cases of severe dengue. Being aware of these predictors are crucial to advance patient management and provide counseling for clinical decisions. Methods: This cross sectional analytical study was conducted at Dhaka Shishu (Children) Hospital from May 2019 to February 2020. Using convenient sampling the study enrolled a total of 350 children with severe dengue. Of these 16 died, and 334 survived. Comparisons of physiologic, clinical and laboratory parameters between survival and mortality groups were performed to identify predictors of death. Results: The majority (81%) of incidents were in children aged 5 to 10 years who attended. There was no significant differences in gender of the patients. The clinical predictors of mortality were major bleeding, plasma leakage (P >20% rise in hematocrit, ascites, pleural effusion), hepatomegaly, and refractory shock (p<0.05). Laboratory findings in the group with high mortality were thrombocytopenia (<15,000/mm³), elevated liver enzymes (ALT, AST), prolonged PT/INR, hypoalbuminemia and high ferritin values (p<0.001). Conclusion: In children with severe dengue, major bleeding, plasma leakage, refractory shock, severe thrombocytopenia, and raised ferritin were significant predictors of mortality. Knowing early the presence of these risk factors will enable timely and judicious management in at risk children to improve outcomes.
Published Version
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