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Abstract
Dengue Fever (DF) is the commonest mosquito-borne viral infection that results in hospitalisation amongst patients in Malaysia. The cornerstone of managing dengue virus infection is the prediction hence prevention of severe DF from developing. Warning signs proposed by WHO as clinical predictors of severe DF are insensitive. Procalcitonin (PCT) has been shown to increase in bacterial infections and is useful in predicting disease severity and mortality. Objective: To determine the level of PCT and other clinical and biochemical parameters associated with severe DF. This is a cross-sectional study conducted over 6 months from September 2017 to February 2018. Patients aged 18 years and above who were hospitalised in Hospital Selayang for a serologically-confirmed DF were recruited. PCT level was taken within 24 h of hospital admission and patients were followed up throughout admission until discharge or death. Out of 133 recruits, 117 (88%) had uncomplicated DF and 16 (12%) had severe DF either with shock (44%) or organ failure (56%). There were 2 (13%) deaths from the severe group. Median PCT levels were higher in severe [0.35 ng/mL (0.15-4.4)] versus non-severe [0.28 ng/mL (0.17-0.54)] DF, however there was no significant difference between both groups (p = 0.518). Other significant clinical and biochemical factors associated with severe DF were defervescence phase (p = 0.043), lethargy (p = 0.000) and albumin 0.3 ng/mL predict severe DF with a sensitivity of 73% and specificity of 85%. PCT [median 3.6 ng/mL (3.2-4.0)] is also significantly associated with death (p = 0.021). PCT at a cut-off of >0.3 ng/mL predicts severe DF when combined with lethargy and albumin <35g/L. Furthermore, PCT is significantly associated with death
Highlights
Dengue Fever (DF) is one of the most important arthropod-borne viral diseases owing to its high morbidity and mortality
While most patients presented on median day 5 (IQR 4-6) of illness, those with severe Dengue fever tend to present in defervescence phase and those with nonsevere Dengue fever in febrile phase
Other warning signs were not significantly associated with severe DF, making warning signs a non-specific, non-sensitive and unreliable tool in classifying or prognosticating patients with DF. Laboratory parameters such as renal profile, electrolytes, AST and bilirubin showed no significant difference across board
Summary
Dengue Fever (DF) is one of the most important arthropod-borne viral diseases owing to its high morbidity and mortality. In 2015, the World Health Organization (WHO) of Western Pacific Region (WPRO) reported DF as the fastest emerging arboviral infection. About half of the world's population is at risk of the infection. Mortality of DF can be as high as 20% if untreated, whereas if recognised earlier and managed appropriately, it is less than 1% (Simmons et al, 2012; Lin et al, 2013). In Malaysia, Dengue fever is a serious public health concern with an escalating trend of infection. Since the year 2000, its incidence in Malaysia continued to increase from 32 cases per 100,000 populations to 328.3 cases per 100,000 populations in 2016, resulting in a 10-fold surge in incidence rate in 16 years. According to the Crisis Preparedness and Response Centre (CPRC) of Ministry of Health
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