OP-025 Clinical and laboratory predictors for severity in dengue in children needing picu referral

• Published in: BMJ paediatrics open Vol. 8; no. Suppl 5; p. A11
• Main Authors: Shanmuga Sundarapandian, Lalitha Rajalakshmi, Kandasamy, Sasidaran, Sangaralingam, Thangavelu, Krishnamoorthy, Nedunchelian
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 11.07.2024; BMJ Publishing Group LTD
• Subjects: dengue; Laboratories; Obesity; Oliguria; Oral Presentation; Paediatric dengue; Paediatric intensive care; Pediatrics; severe dengue; tropical disease
• ISSN: 2399-9772
• DOI: 10.1136/bmjpo-2024-EPAC.25

AimTo assess the predictors of severe dengue in children with the onset of critical phase.Material and MethodCase control analysis of data from case records of children <18 years with serologically confirmed dengue infection admitted to tertiary center in South India between January - December 2019. Demographic, clinical and laboratory parameters were analysed using Chi square/Student t- test. p <0.05 considered as significant. Odds Ratios (95% Confidence Interval) by multivariable polytomous logistic regression analysis used to associate the prognostic indicators for dengue severity.ResultsOf the 336 case records analysed, 104 (30.9%) were admitted to intensive/high dependency care and 55 (16.3%) required supports including blood products, vasoactive support, ventilatory support and/or continuous kidney replacement therapy. Severe dengue was significantly associated with clinical factors like early onset of critical phase <4 days (p 0.02); desaturation (p 0.01); 3 or more warning signs as per WHO guidelines, obesity, oliguria, and need for crystalloid bolus >20 ml/kg, colloid bolus >10 ml/kg (p 0.001), Laboratory factors namely rapid fall in platelet count >50%, haematocrit rise >20% from previous value, transaminitis >200IU/L, hyperlactatemia >2 mmol/L, hyperferritinemia>500 mcg/L, LDH >500 IU, and INR >1.5 (p 0.001) were more significantly associated with severe dengue (table 1). Among these independent predictive factors for severe dengue [OR(95%CI), p-value] were Rapid platelet fall >50% [22.00(2.69–180.08),0.001], Hematocrit rise >20% [4.57(1.53–13.64),0.006], hyperferritinemia [46.71(15.18–143.67),0.000], obesity [16.36(2.10–127.11),0.008], ≥ 3 warning signs [29.33(10.43–82.45),0.001], oliguria [17.94(1.10–411.76),0.04], hyperlactatemia [17.05(2.68 -108.21),0.003], and elevated LDH [10.20(1.09 -106.19),0.04].Abstract OP-025 Table 1Comparison of clinical and laboratory characteristics of children with severe and nonsevere dengue Parameter Non severe dengue n=227 n(%) Severe Dengue n=104 n(%) p value* Age - InfancyAge - >12 years 20 (8.81%)35 (15.42%) 16 (15.38%)23 (22.11%) 0.02 Comorbidities 16 (7.05%) 15(14.42%) 0.10 Obesity 4 (1.76%) 19 (18.26%) 0.001 Warning signs ≥3 20 (8.81%) 83 (79.80%) 0.001 Early onset of critical phase (<4 days) 28 (12.33%) 22 (21.15%) 0.02 CRP positive 38 (16.74%) 22 (21.15%) 0.61 Oliguria 2 (0.88%) 23 (22.11%) 0.001 Major bleeding 0 (0.00%) 2 (1.92%) 0.11 Desaturation 0 (0.00%) 5 (4.80%) 0.01 Altered sensorium 0 (0.00%) 2 (1.92%) 0.11 Bolus (Crystalloid) >20 ml/kg 0 (0.00%) 9 (86.5%) 0.001 Bolus (Colloid) >10 ml/kg 1 (0.44%) 7 (6.73%) 0.001 Hematocrit rise >20% 31 (13.66%) 52 (50%) 0.001 Platelet fall >50% 3 (1.32%) 37 (35.57%) 0.001 Transaminitis200–500 U/L>500U/L 10 (4.41%)0(0.00%) 15(14.42%)5(4.80%) 0.001 Lactate >2 mmol/L 3 (1.32%) 43(41.34%) 0.001 Ferritin500 – 10000 µg/L>10000 µg/L 42 (18.50%)1 (0.44%) 73(70.19%)12(11.53%) 0.001 LDH >500 IU/L 1 (0.44%) 34(32.69%) 0.001 INR>1.5 0 (0.00%) 8(7.69%) 0.001 *Chi square test, CRP – C- reactive protein, LDH – lactate dehydrogenase, INR – international normalized ratioConclusionsObesity, rapid fall in platelet count >50%, hematocrit rise >20%, ≥ 3 warning signs, oliguria, hyperferritinemia, hyperlactatemia, and elevated LDH have been identified to independently predict severe dengue especially the need for advanced PICU care for various supports and utilising these parameters in early critical phase will help prognosticate for severity and early referral to PICU to prevent deaths.