Dengue Score Research Articles

Development and validation of a bedside dengue severity score for predicting severe dengue in children

Development and validation of a bedside dengue severity score for predicting severe dengue in children

CORRELATION OF DENGUE SCORE WITH THE SEVERITY OF DENGUE

Background : Dengue is one of the most prevalent vector borne diseases worldwide. Dengue fever presents with wide clinical spectrum ranging from self limiting infection to severe dengue. Aim: Present study is done to correlate a novel indicator 'Dengue Score' with the severity of dengue. Methods: A 2 year cross-sectional study was conducted among patients presenting with Dengue fever at BMCRI, Bangalore. Results : A total of 55 patients were included in the study. Mean age in the study was 42 years. Out of 55 patients, 33(60%) were males and 22(40%) were females. 36 had dengue fever without warning signs, 13 had Dengue fever with warning signs and 6 had severe dengue. Dengue score of 2 was associated with Hemoconcentration and severe thrombocytopenia. Dengue score of 3 or more was associated with Severe Dengue. Conclusion: Present study showed that Higher Dengue Score is associated with increased risk of plasma leakage and Severe Dengue. It is a simple scoring system, which uses laboratory parameters that are routinely measured in clinical practice

Toward developing a scoring system for dengue fever in children

Background: Dengue is a rapidly increasing global public health problem especially in tropical countries. Dengue is a benign and self-limiting febrile illness in the majority of children but in some children, it can progress to severe dengue (SD) resulting in shock, hemorrhage, and death. Aims and Objectives: The aims of this study were to develop a scoring system to predict dengue infection severity. Materials and Methods: This prospective and observational study was conducted on all children admitted with dengue fever at a tertiary teaching institute in India. Daily scoring was done for pulse rate, respiratory rate, blood pressure, hematocrit, platelet count (scores 1–3), and systemic complications (0 if absent, 3 if present). Then, highest score recorded during the hospitalization period was taken for statistical analysis. Results: A total of 194 cases were classified into probable dengue (PD) 134 (69.1%), dengue with warning signs (DWS) 41 (21.1%), and SD 19 (9.8%) as per the WHO 2009 classification. Mean age of presentation was 11.5 years. The most common presenting symptoms were fever (97.9%), vomiting (73.1%) and signs noticed were flushing (63.4%), hepatomegaly (34.5%), and periorbital puffiness (27.3%). Among 134 children with PD, 116 (86.5%) had dengue severity score 5–6, with only 18 (13.5%) had score 7–13, whereas all 60 (100%) children with DWS and SD had score 7–13, none of them had score <7. Hence, a severity score of >7 identified all children with DWS and SD with overestimation in 13.5% children with PD. Conclusion: Daily dengue severity score of >7 indicates the high probability of DWS and SD. However, this scoring system should be validated by similar studies in different settings before we can apply in routine clinical practice.

DAILY DENGUE SEVERITY SCORE – IMPLICATIONS, BENEFITS AND LIMITATIONS IN OUR SETTING

Introduction- Dengue is associated with high morbidity & at times develops potentially fatal complication. Predicting the outcome on the basis of clinical presentation alone is less reliable and complicated owing to variable symptomatology. there is a need for developing and testing a scoring system, for the detection of complicated and severe dengue fever early in the course of infection, to identify those children who may progress to DSS/DHF and succumb to disease subsequently & to triage sick patients for early referral from primary and community health centers to higher center for intensive care management. This Material & methodsProspective observational study was conducted in Department of Pediatrics, SMS Medical College, Jaipur during January 2020 to September 2021. Sample size is calculated at 95 % condence interval expecting sensitivity of 86% using dengue severity score of more than equal to 12 in the assessment of outcome of dengue severity among the dengue fever patients. An absolute allowable error of 15% and at prevalence of 17.4% of severe dengue patients, the required sample size was 125 cases with dengue fever. Statistical analyses were done using computer software (SPSS Trial version 23 and primer). if we use the critical cut off of DDS Results- S >10.5 on day 1 of hospital admission; it was a strong predictor of mortality with p <0.001 and area under curve was 0.906 which is near 1. The sensitivity of score at this cutoff was 100% and specicity was 71.7%. The cutoff was chosen as 10.5 because at this cut off both sensitivity and specicity were reasonably high and below this score although sensitivity remains 100% but specicity decreases i.e., false positive cases would increase and if cutoff is increased then specicity increases but sensitivity decreases i.e., false negative increases. If cutoff was chosen at 16.5 sensitivity of score decreases to 83.3% but specicity increases to 85%. On cutoff of 22 sensitivity decreases to 50% and specicity increases to 90.3%. Conclusions- If critical cutoff more than 10.5 is used, dengue shock syndrome can be predicted with specicity of 82.5% and sensitivity of 94.6%. If critical cutoff of more than 8.5 is used, prolonged length of hospital stay can be predicted with sensitivity and specicity of 51.9% and 53.1% respectively. If critical cutoff of more than 11.5 is used then organ dysfunction in dengue patients can be predicted with sensitivity of 78.9% and specicity of 89.7% respectively. If critical cutoff of more than 10.5 is used then mortality in dengue patients can be predicted with sensitivity100% of and specicity of 71.7%

Dengue Score: Predictor of Plasma Leakage

Background: Many biochemical and hematological changes occur in dengue infection, which is dependent on the clinical disease. The Dengue Score (DS) is a useful tool for anticipating plasma leakage. The platelet count, hematocrit (Hct), aspartate aminotransferase (AST) ratio and albumin is used for it. Aim: To predict a score useful to detect dengue hemorrhagic fever. Method: The study was retrospective observational. It is done in Dengue wards in Ghurki teaching hospital Lahore and Mayo Hospital Lahore. In the study 100 patients record was taken who were admitted from August 2021 to November 2021. A proforma was filled. SPSS 23 was used for statistical analysis of the data. Results: The mean age was 38.32±13.713. Out of 100 patients 57(57%) were male while 43(43%) were female. 32 were included in dengue score (DS) ≤1, 33 were included in dengue score = 2 and 35 were included in dengue score ≥3. Ascites developed in 6 patients with DS ≤1, 24 with DS ═2, 31 with DS ≥3. Pleural effusion developed in 3 with DS ≤1, 20 with DS ═2, 21 with DS ≥3 so It showed significant association of effusion and ascites with DS = 2 and score ≥3. Conclusion: Dengue score can be calculated by change in hemoconcentration, platelets, serum albumin and AST ratio so it can be used to predict plasma leakage which is part of dengue hemorrhagic fever. Keywords: Dengue Score (DS), Plasma Leakage, Pleural effusion, Ascites

Differentiating COVID-19 and dengue from other febrile illnesses in co-epidemics: Development and internal validation of COVIDENGUE scores

ObjectivesThe purpose of this cohort study was to develop two scores able to differentiate coronavirus 2019 (COVID-19) from dengue and other febrile illnesses (OFIs). MethodsAll subjects suspected of COVID-19 who attended the SARS-CoV-2 testing center of Saint-Pierre hospital, Reunion, between March 23 and May 10, 2020, were assessed for identifying predictors of both infectious diseases from a multinomial logistic regression model. Two scores were developed after weighting the odd ratios then validated by bootstrapping. ResultsOver 49 days, 80 COVID-19, 60 non-severe dengue and 872 OFIs were diagnosed. The translation of the best fit model yielded two scores composed of 11 criteria: contact with a COVID-19 positive case (+3 points for COVID-19; 0 point for dengue), return from travel abroad within 15 days (+3/-1), previous individual episode of dengue (+1/+3), active smoking (−3/0), body ache (0/+5), cough (0/-2), upper respiratory tract infection symptoms (−1/-1), anosmia (+7/-1), headache (0/+5), retro-orbital pain (−1/+5), and delayed presentation (>3 days) to hospital (+1/0). The area under the receiver operating characteristic curve was 0.79 (95%CI 0.76–0.82) for COVID-19 score and 0.88 (95%CI 0.85–0.90) for dengue score. Calibration was satisfactory for COVID-19 score and excellent for dengue score. For predicting COVID-19, sensitivity was 97% at the 0-point cut-off and specificity 99% at the 10-point cut-off. For predicting dengue, sensitivity was 97% at the 3-point cut-off and specificity 98% at the 11-point cut-off. ConclusionsCOVIDENGUE scores proved discriminant to differentiate COVID-19 and dengue from OFIs in the context of SARS-CoV-2 testing center during a co-epidemic.

Development of a bedside score to predict dengue severity

BackgroundIn 2017, New Caledonia experienced an outbreak of severe dengue causing high hospital burden (4379 cases, 416 hospital admissions, 15 deaths). We decided to build a local operational model predictive of dengue severity, which was needed to ease the healthcare circuit.MethodsWe retrospectively analyzed clinical and biological parameters associated with severe dengue in the cohort of patients hospitalized at the Territorial Hospital between January and July 2017 with confirmed dengue, in order to elaborate a comprehensive patient’s score. Patients were compared in univariate and multivariate analyses. Predictive models for severity were built using a descending step-wise method.ResultsOut of 383 included patients, 130 (34%) developed severe dengue and 13 (3.4%) died. Major risk factors identified in univariate analysis were: age, comorbidities, presence of at least one alert sign, platelets count < 30 × 109/L, prothrombin time < 60%, AST and/or ALT > 10 N, and previous dengue infection. Severity was not influenced by the infecting dengue serotype nor by previous Zika infection.Two models to predict dengue severity were built according to sex. Best models for females and males had respectively a median Area Under the Curve = 0.80 and 0.88, a sensitivity = 84.5 and 84.5%, a specificity = 78.6 and 95.5%, a positive predictive value = 63.3 and 92.9%, a negative predictive value = 92.8 and 91.3%. Models were secondarily validated on 130 patients hospitalized for dengue in 2018.ConclusionWe built robust and efficient models to calculate a bedside score able to predict dengue severity in our setting. We propose the spreadsheet for dengue severity score calculations to health practitioners facing dengue outbreaks of enhanced severity in order to improve patients’ medical management and hospitalization flow.

Knowledge towards Prevention and Management of Dengue: A Cross-sectional Study among Dental, Medical and Pharmacy Students in a Private University, Malaysia

Aim: The aim and objectives of the study were: 1) To assess the knowledge regarding dengue viral infection among undergraduate healthcare professional (HCP) students. 2) To investigate the association of socio-demographic factors towards dengue knowledge among the study participants. 3) To compare the dengue knowledge among the three HCP (Dental, Medical and Pharmacy) students.&#x0D; Study Design: A cross sectional study design was used in the study.&#x0D; Place and Duration of Study: The study was conducted in AIMST University campus, Kedah state, Malaysia between January, 2017 and June, 2017.&#x0D; Methods: The study was conducted among HCP students using pre-validated questionnaire with knowledge as a single dependent variable. The questionnaire was distributed in class room setting after obtaining informed consent forms signed by participants. The summary statistics for categorical variables was used with chi-square test to see if there was any association between the variables. Inferential statistics was done using Spearmans correlation.&#x0D; Results: Among the 636 participants, an overall good knowledge (≈90%) was observed regarding the cause, breeding sites and common clinical symptoms of dengue fever. However, poor knowledge was observed regarding the time of dengue mosquitoes bite (51%, P = .58) and transmission through blood transfusion (59%, P &lt;.001). Very poor knowledge was observed regarding transmission through person to person contact (25%, P &lt;.001). The median knowledge score was 12(3) ranging from 0 to 15. There was a statistically significant differences (P &lt; .001) in response to 14/15 knowledge based items. Further, a statistically significant association between dengue knowledge score was observed among field of study (P &lt; .05) and year of study (P &lt; .006) variables. The Spearman's correlation test showed a weak positive correlation [rs(2) = 8.6, P &lt; .01] and [rs(10) = 108, P &lt; .001] between year of study and age categories for dengue knowledge scores.&#x0D; Conclusion: Overall, the HCP students in AIMST University showed good knowledge score towards dengue however, educational intervention programmes can further enrich their knowledge in the prevention, treatment and management of this deadly disease.

Daily Dengue Severity Score to Assess Severe Manifestations.

The study aimed to develop dengue severity score to assess severe manifestations among hospitalized patients with dengue infection. Children and adolescents with serologically confirmed dengue infection admitted at Ramathibodi Hospital from 2004 to 2018 and treated by an expert multidisciplinary team were recruited. Medical records were retrospectively reviewed and 14 items, related to clinical parameters and managements during hospitalization, were obtained daily as dengue severity score. A total of 191 patients with a mean age of 10.7 years from 2004 to 2013 were recruited. They were classified as dengue fever (35), dengue hemorrhagic fever (DHF) I (53), II (50), III (37) and IV (16). The analysis of 593 daily records revealed the range of daily severity score among patients with DHF grades III (10-20) and IV (31-47) were significantly higher than those of other groups (dengue fever, 5-13; DHF I, 2-10; DHF II, 6-11) with P-values of 0.0001. Using a validity test, a total daily score of ≥12 was an assessment tool for dengue shock syndrome with sensitivity, 86% and specificity, 84%. An additional 51 hospitalized patients with DHF grades II, III and IV with similar ages from 2014 to 2018 were recruited. The number of patients with severe manifestations, having daily score of ≥12, was significantly higher than those without severe manifestations starting from Day -3 to Day +1 of illness. Daily dengue severity score of ≥12 was an accurate assessment tool for severe manifestations.

Dengue Risk Score Development Towards Early Warning of Severe Dengue Infection Among Thai Adults

Dengue Risk Score Development Towards Early Warning of Severe Dengue Infection Among Thai Adults

The acceptance and willingness to pay (WTP) for hypothetical dengue vaccine in Penang, Malaysia: a contingent valuation study

BackgroundMalaysia has been experiencing an escalation in dengue cases since the past 5 years. As the dengue vaccine pipeline continues to develop steadily with strong public interests, this study had been sought to elicit the acceptance and the willingness to pay (WTP) for hypothetical dengue vaccine in Malaysia.MethodsThis study adopted the cross-sectional, contingent valuation study that involved 400 respondents in Penang, Malaysia. The double-bounded dichotomous choice via bidding game approach was employed to elicit the WTP value for two hypothetical 3-doses dengue vaccines (Vaccines A and B with 5- and 10-years’ protection, respectively against dengue). A univariate logistic regression model was employed to assess the key determinants of vaccine acceptance, while the mean WTP value and its associated factors were measured by using the parametric two-part model (TPM).ResultsDengue vaccine appeared to be highly acceptable (88.4%) among the population in Penang, Malaysia. Respondents who were of Chinese ethnicity (OR 0.36, p = 0.017), with higher dengue knowledge score (OR 1.43, p = 0.016), and higher vaccination attitude score (OR 1.91, p < 0.001) were more likely to accept the vaccine. The first step logit estimation from TPM displayed that pensioners (OR 2.37, p = 0.036), respondents who were self-employed or working in the private sector (OR 1.21, p = 0.002), respondents with higher education level (OR 2.09–3.29, p < 0.05), and those who accepted the vaccine (OR 3.23, p = 0.001) were more likely to pay for the vaccine. The adjusted mean WTP value for the vaccine was MYR39.21 (USD9.45) per dose. Next, the second-stage regression from TPM revealed the key factors that significantly affected the WTP value, which were composed of age, gender, occupation, household income, dengue prevention practice, and protection duration of the vaccine. The pensioners and those with better dengue prevention practice were willing to pay more for the vaccines. Additionally, all the respondents elicited a higher WTP amount toward the vaccine with longer protection duration (Vaccine B).ConclusionStrong acceptance toward dengue vaccine reflects the high value of the vaccine in Malaysia. The WTP estimates offer quantification of the private benefit in reducing occurrences of the disease. Besides, the people’s preferences-based WTP value for the vaccine tends to complement scientific decision-making and prioritization in the management of dengue in the country.

Dengue score as a diagnostic predictor for pleural effusion and/or ascites: external validation and clinical application

BackgroundThe Dengue Score is a model for predicting pleural effusion and/or ascites and uses the hematocrit (Hct), albumin concentration, platelet count and aspartate aminotransferase (AST) ratio as independent variables. As this metric has not been validated, we conducted a study to validate the Dengue Score and assess its clinical application.MethodsA retrospective study was performed at a private hospital in Jakarta, Indonesia. Patients with dengue infection hospitalized from January 2011 through March 2016 were included. The Dengue Score was calculated using four parameters: Hct increase≥15.1%, serum albumin≤3.49 mg/dL, platelet count≤49,500/μL and AST ratio ≥ 2.51. Each parameter was scored as 1 if present and 0 if absent. To validate the Dengue Score, goodness-of-fit was used to assess calibration, and the area under the receiver operating characteristic curve (AROC) was used to assess discrimination. Associations between clinical parameters and Dengue Score groups were determined by bivariate analysis.ResultsA total of 207 patients were included in this study. The calibration of the Dengue Score was acceptable (Hosmer-Lemeshow test, p = 0.11), and the score’s discriminative ability was good (AROC = 0.88 (95% CI: 0.83–0.92)). At a cutoff of ≥2, the Dengue Score had a positive predictive value (PPV) of 79.03% and a negative predictive value (NPV) of 90.36% for the diagnostic prediction of pleural effusion and/or ascites. Compared with the Dengue Score ≤ 1 group, the Dengue Score = 2 group was significantly associated with hemoconcentration> 20% (p = 0.029), severe thrombocytopenia (p = 0.029), and increased length of hospital stay (p = 0.003). Compared with the Dengue Score = 2 group, the Dengue Score ≥ 3 group was significantly associated with hemoconcentration> 20% (p = 0.001), severe thrombocytopenia (p = 0.024), severe dengue (p = 0.039), and increased length of hospital stay (p = 0.011).ConclusionThe Dengue Score performed well and can be used in daily practice to help clinicians identify patients who have plasma leakage associated with severe dengue.

A climate-based prediction model in the high-risk clusters of the Mekong Delta region, Vietnam: towards improving dengue prevention and control.

To develop a prediction score scheme useful for prevention practitioners and authorities to implement dengue preparedness and controls in the Mekong Delta region (MDR). We applied a spatial scan statistic to identify high-risk dengue clusters in the MDR and used generalised linear-distributed lag models to examine climate-dengue associations using dengue case records and meteorological data from 2003 to 2013. The significant predictors were collapsed into categorical scales, and the β-coefficients of predictors were converted to prediction scores. The score scheme was validated for predicting dengue outbreaks using ROC analysis. The north-eastern MDR was identified as the high-risk cluster. A 1°C increase in temperature at lag 1-4 and 5-8weeks increased the dengue risk 11% (95% CI, 9-13) and 7% (95% CI, 6-8), respectively. A 1% rise in humidity increased dengue risk 0.9% (95% CI, 0.2-1.4) at lag 1-4 and 0.8% (95% CI, 0.2-1.4) at lag 5-8weeks. Similarly, a 1-mm increase in rainfall increased dengue risk 0.1% (95% CI, 0.05-0.16) at lag 1-4 and 0.11% (95% CI, 0.07-0.16) at lag 5-8weeks. The predicted scores performed with high accuracy in diagnosing the dengue outbreaks (96.3%). This study demonstrates the potential usefulness of a dengue prediction score scheme derived from complex statistical models for high-risk dengue clusters. We recommend a further study to examine the possibility of incorporating such a score scheme into the dengue early warning system in similar climate settings.

Dengue score: a proposed diagnostic predictor for pleural effusion and/or ascites in adults with dengue infection.

BackgroundThere are several limitations in diagnosing plasma leakage using the World Health Organization (WHO) guidelines of dengue hemorrhagic fever. We conducted a study to develop a dengue scoring system to predict pleural effusion and/or ascites using routine laboratory parameters.MethodsA prospective observational study was carried out at Cipto Mangunkusumo Hospital and Persahabatan Hospital, Jakarta, Indonesia. Dengue-infected adults admitted on the third febrile day from March, 2010 through August, 2015 were included in the study. A multivariate analysis was conducted to determine the independent diagnostic predictors of pleural effusion and/or ascites and to convert the prediction model into a scoring system.ResultsA total of 172 dengue-infected adults were enrolled in the study. Of the 172 patients, 101 (58.7 %) developed pleural effusion and/or ascites. A multivariate analysis was conducted to determine the independent diagnostic predictors of pleural effusion and/or ascites in dengue-infected adults. The predictors were scored based on the following calculations: hemoconcentration ≥15.1 % had a score of 1 (OR, 3.11; 95 % CI, 1.41–6.88), lowest albumin concentration at critical phase ≤3.49 mg/dL had a score of 1 (OR, 4.48; 95 % CI, 1.87–10.77), lowest platelet count ≤49,500/μL had a score of 1 (OR, 3.62; 95 % CI, 1.55–8.49), and elevated ratio of AST ≥2.51 had a score of 1 (OR 2.67; 95 % CI, 1.19–5.97). At a cut off of ≥ 2, the Dengue Score predicted pleural effusion and/or ascites diagnosis with positive predictive value of 79.21 % and negative predictive value of 74.63 %. This prediction model is suitable for calibration and good discrimination.ConclusionsWe have developed a Dengue Score that could be used to identify pleural effusion and/or ascites and might be useful to stratify dengue-infected patients at risk for developing severe dengue.

Practices of Dengue Fever Prevention and the Associated Factors among the Orang Asli in Peninsular Malaysia.

BackgroundDengue is prevalent among Malaysia's indigenous peoples, known as the Orang Asli, and it poses a serious health threat to them. The study aims to look at the socio-demographic factors, health beliefs, and knowledge about dengue and its association to dengue prevention practices among Orang Asli communities in Peninsular Malaysia.MethodsA cross-sectional survey was conducted in 16 randomly selected Orang Asli villages from eight states in Peninsular Malaysia from April 2012 until February 2013.ResultsA total of 560 Orang Asli were interviewed and 505 completed the survey. Slightly above half of the participants (n = 280, 55.4%) had a total dengue prevention score of 51–100 (of a possible score of 0–100). Multivariate analysis findings showed dengue knowledge, perceived barriers to perform dengue prevention, fogging frequency, and perceived susceptibility to dengue fever as significant factors associated to dengue prevention practices. Participants with a lower dengue knowledge score (score 0–18) were less likely (OR = 0.63, 95%CI = 0.44–0.92 vs. score 19–36, P = 0.015) to practice dengue prevention. Participants with low perceived barriers to prevent dengue (score of 1–5) were more likely (OR = 2.06, 95%CI = 1.21–3.53, vs. score of 6–10, P = 0.008) to practice dengue prevention. Villages that were not fogged (OR = 0.49, 95%CI = 0.24–0.99, P = 0.045) or rarely fogged (OR = 0.40, 95%CI = 0.22–0.75, P = 0.004) had lower dengue prevention practices than villages that were fogged often. Participants with low perceived susceptibility of acquiring dengue (score of 1–5) were less likely (OR = 0.54, 95%CI = 0.33–0.89 vs. score of 6–10, P = 0.018) to practice dengue prevention measures.ConclusionFindings imply that educational and health programmes should focus on enhancing dengue knowledge and perceived susceptibility of acquiring dengue and reducing perceived barriers to performing dengue prevention practices among the Orang Asli. More outreach on mosquito control campaigns should be carried out especially in villages where mosquito fogging is frequent.