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Early diagnosis of dengue disease severity in a resource-limited Asian country

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ABSTRACT

Background: Dengue is endemic throughout Cambodia, a country faced with significant health and economic challenges. We undertook a clinical study at the National Paediatric Hospital in Phnom Penh to evaluate clinical diagnostic parameters for dengue and predictors of disease outcome.

Methods: Between September 2011 and January 2013, all consecutive inpatients aged between 1 and 15 years and presenting with suspected dengue were enrolled. They were clinically assessed using both the 1997 and 2009 WHO dengue classifications. Specimens were collected upon admission and discharge and tested for dengue at Institut Pasteur in Cambodia.

Results: A total of 701 patients were screened. Of these, 79 % were dengue-confirmed by laboratory testing, and 21 % tested dengue-negative. A positive tourniquet test, absence of upper respiratory symptoms, leukopenia, thrombocytopenia, and elevated liver transaminases were independent predictors for laboratory-confirmed dengue among the children. The presence of several warning signs on hospital admission was associated with a concurrent laboratory-confirmed diagnosis of severe disease outcome.

Conclusions: The presence of two or more warning signs was associated with a concurrent laboratory-confirmed diagnosis of severe dengue at hospital admission. Thus, a cumulative score combining simple clinical parameters and first-line laboratory findings could be used to accurately predict dengue virus infection in pediatric populations, optimizing triage in settings with limited laboratory resources.

Electronic supplementary material: The online version of this article (doi:10.1186/s12879-016-1849-8) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus

Received-operator characteristics (ROC) curves comparing the predictive accuracy for Severe Dengue of various models integrating one or several warning signs, and presenting the values of the Area Under Curve (AUC) coefficients. National Paediatric Hospital, Phnom Penh, Sep. 2011–Jan. 2013
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Fig3: Received-operator characteristics (ROC) curves comparing the predictive accuracy for Severe Dengue of various models integrating one or several warning signs, and presenting the values of the Area Under Curve (AUC) coefficients. National Paediatric Hospital, Phnom Penh, Sep. 2011–Jan. 2013

Mentions: The ROC curves (Figs. 2 and 3) illustrate the accuracy of these various models in predicting concurrent diagnosis of laboratory-confirmed DHF/DSS or SD at hospital admission, based on the total number of WS included in each model. For DHF/DSS, the highest predictive value was obtained when patients presented two or more WS upon admission (AUC = 0.78). For SD, predictive value was maximized when patients presented with at least three WS at admission (AUC = 0.81).Fig. 2


Early diagnosis of dengue disease severity in a resource-limited Asian country
Received-operator characteristics (ROC) curves comparing the predictive accuracy for Severe Dengue of various models integrating one or several warning signs, and presenting the values of the Area Under Curve (AUC) coefficients. National Paediatric Hospital, Phnom Penh, Sep. 2011–Jan. 2013
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5036306&req=5

Fig3: Received-operator characteristics (ROC) curves comparing the predictive accuracy for Severe Dengue of various models integrating one or several warning signs, and presenting the values of the Area Under Curve (AUC) coefficients. National Paediatric Hospital, Phnom Penh, Sep. 2011–Jan. 2013
Mentions: The ROC curves (Figs. 2 and 3) illustrate the accuracy of these various models in predicting concurrent diagnosis of laboratory-confirmed DHF/DSS or SD at hospital admission, based on the total number of WS included in each model. For DHF/DSS, the highest predictive value was obtained when patients presented two or more WS upon admission (AUC = 0.78). For SD, predictive value was maximized when patients presented with at least three WS at admission (AUC = 0.81).Fig. 2

View Article: PubMed Central - PubMed

ABSTRACT

Background: Dengue is endemic throughout Cambodia, a country faced with significant health and economic challenges. We undertook a clinical study at the National Paediatric Hospital in Phnom Penh to evaluate clinical diagnostic parameters for dengue and predictors of disease outcome.

Methods: Between September 2011 and January 2013, all consecutive inpatients aged between 1 and 15 years and presenting with suspected dengue were enrolled. They were clinically assessed using both the 1997 and 2009 WHO dengue classifications. Specimens were collected upon admission and discharge and tested for dengue at Institut Pasteur in Cambodia.

Results: A total of 701 patients were screened. Of these, 79 % were dengue-confirmed by laboratory testing, and 21 % tested dengue-negative. A positive tourniquet test, absence of upper respiratory symptoms, leukopenia, thrombocytopenia, and elevated liver transaminases were independent predictors for laboratory-confirmed dengue among the children. The presence of several warning signs on hospital admission was associated with a concurrent laboratory-confirmed diagnosis of severe disease outcome.

Conclusions: The presence of two or more warning signs was associated with a concurrent laboratory-confirmed diagnosis of severe dengue at hospital admission. Thus, a cumulative score combining simple clinical parameters and first-line laboratory findings could be used to accurately predict dengue virus infection in pediatric populations, optimizing triage in settings with limited laboratory resources.

Electronic supplementary material: The online version of this article (doi:10.1186/s12879-016-1849-8) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus