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Identifying Adult Dengue Patients at Low Risk for Clinically Significant Bleeding

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  • Joshua G X Wong
  • Tun Linn Thein
  • Yee-Sin Leo
  • Junxiong Pang
  • David C Lye

Abstract

Background: Clinically significant bleeding is important for subsequent optimal case management in dengue patients, but most studies have focused on dengue severity as an outcome. Our study objective was to identify differences in admission parameters between patients who developed clinically significant bleeding and those that did not. We sought to develop a model for discriminating between these patients. Methods: We conducted a retrospective study of 4,383 adults aged >18 years who were hospitalized with dengue infection at Tan Tock Seng Hospital, Singapore from 2005 to 2008. Patients were divided into those with clinically significant bleeding (n = 188), and those without (n = 4,195). Demographic, clinical, and laboratory variables on admission were compared between groups to determine factors associated with clinically significant bleeding during hospitalization. Results: On admission, female gender (p 38°C (p 38°C (aOR 1.81; 95% CI: 1.27–2.61), nausea/vomiting (aOR 1.39; 95% CI: 0.94–2.12), ANC (aOR 1.3; 95% CI: 1.15–1.46), ALC (aOR 0.4; 95% CI: 0.25–0.64), hematocrit percentage (aOR 0.96; 95% CI: 0.92–1.002) and platelet count (aOR 0.993; 95% CI: 0.988–0.998). At the cutoff of -3.919, the model achieved an AUC of 0.758 (sensitivity:0.87, specificity: 0.38, PPV: 0.06, NPV: 0.98). Conclusion: Clinical risk factors associated with clinically significant bleeding were identified. This model may be useful to complement clinical judgement in triaging adult dengue patients given the dynamic nature of acute dengue, particularly in pre-identifying those less likely to develop clinically significant bleeding.

Suggested Citation

  • Joshua G X Wong & Tun Linn Thein & Yee-Sin Leo & Junxiong Pang & David C Lye, 2016. "Identifying Adult Dengue Patients at Low Risk for Clinically Significant Bleeding," PLOS ONE, Public Library of Science, vol. 11(2), pages 1-12, February.
    • Handle: RePEc:plo:pone00:0148579
    DOI: 10.1371/journal.pone.0148579
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    1. Samir Bhatt & Peter W. Gething & Oliver J. Brady & Jane P. Messina & Andrew W. Farlow & Catherine L. Moyes & John M. Drake & John S. Brownstein & Anne G. Hoen & Osman Sankoh & Monica F. Myers & Dylan , 2013. "The global distribution and burden of dengue," Nature, Nature, vol. 496(7446), pages 504-507, April.
    2. Nguyen Tien Huy & Tran Van Giang & Dinh Ha Duy Thuy & Mihoko Kikuchi & Tran Tinh Hien & Javier Zamora & Kenji Hirayama, 2013. "Factors Associated with Dengue Shock Syndrome: A Systematic Review and Meta-Analysis," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 7(9), pages 1-15, September.
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