Abstract
Delayed plasma leakage recognition could lead to improper fluid administration resulting in dengue shock syndrome, subsequently, multi-organ failure, and death. This prospective observational study was conducted in Bangkok, Thailand, between March 2018 and February 2020 to determine predictors of plasma leakage and develop a plasma leakage predictive score among dengue patients aged ≥15 years. Of 667 confirmed dengue patients, 318 (47.7%) developed plasma leakage, and 349 (52.3%) had no plasma leakage. Multivariate analysis showed three independent factors associated with plasma leakage, including body mass index ≥25.0 kg/m2 (odds ratio [OR] = 1.784; 95% confidence interval [CI] = 1.040-3.057; P = 0.035), platelet count <100,000/mm3 on fever days 3 to 4 (OR = 2.151; 95% CI = 1.269-3.647; P = 0.004), and aspartate aminotransferase or alanine aminotransferase ≥100 U/l on fever days 3 to 4 (OR = 2.189; 95% CI = 1.231-3.891; P = 0.008). Because these three parameters had evidence of equality, each independent factor was weighted to give a score of 1 with a total plasma-leak score of 3. Higher scores were associated with increased plasma leakage occurrence, with ORs of 2.017 (95% CI = 1.052-3.869; P = 0.035) for score 1, 6.158 (95% CI = 2.914-13.015; P <0.001) for score 2, and 6.300 (95% CI = 2.419-16.407; P <0.001) for score 3. The area under the receiver operating characteristics curves for predicting plasma leakage was good (0.677 [95% CI = 0.616-0.739]). Patients with a plasma-leak score ≥1 had high sensitivity (88.8%), and those with a plasma-leak score of 3 had high specificity (93.4%) for plasma leakage occurrence. This simple and easily accessible clinical score might help physicians provide early and timely appropriate clinical dengue management in endemic areas.
Highlights
Dengue caused by the dengue virus (DENV) and spread by Aedes aegypti mosquito is currently a global burden, and dengue cases have increased by 8 fold over the last 10 years, with 70% of the global burden from Asia [1]
Multivariate analysis showed three independent factors associated with plasma leakage, including body mass index 25.0 kg/m2, platelet count
A previous Brazilian study reported plasma leakage and organ failure as the main indications for dengue patients’ hospitalization, and there was an association between plasma leakage and dengue mortality [7]
Summary
Dengue caused by the dengue virus (DENV) and spread by Aedes aegypti mosquito is currently a global burden, and dengue cases have increased by 8 fold over the last 10 years, with 70% of the global burden from Asia [1]. 60–70% of the patients were adults aged 15 years [2]. The case fatality rate decreased from 0.18 in 2001 to 0.10 in 2016, but the mortality rate was higher in adults aged >40 years, ranging from 0.19–0.30 [2]. A previous study showed dengue shock syndrome (DSS) as the most common cause of death in adults and children with dengue accounted for 73%, followed by severe organ involvement (69%) and severe bleeding (30%) [3]. Delayed plasma leakage recognition could lead to inappropriate fluid management, resulting in DSS and subsequent multi-organ failure and death [4,5,6]. A previous Brazilian study reported plasma leakage and organ failure as the main indications for dengue patients’ hospitalization, and there was an association between plasma leakage and dengue mortality [7]
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