Clinical and laboratory signs associated to serious dengue disease in hospitalized children
Journal Title: Jornal de Pediatria - Year 2016, Vol 92, Issue 5
Abstract
Objective To evaluate the validity of clinical and laboratory signs to serious dengue disease in hospitalized children. Methods Retrospective cohort of children (<18 years) hospitalized with dengue diagnosis (2007–2008). Serious dengue disease was defined as death or use of advanced life support therapy. Accuracy measures and area under the receiver operating characteristic curve were calculated. Results Of the total (n=145), 53.1% were female, 69% aged 2–11 years, and 15.9% evolved to the worse outcome. Lethargy had the best accuracy (positive likelihood ratio >19 and negative likelihood ratio <0.6). Pleural effusion and abdominal distension had higher sensitivity (82.6%). History of bleeding (epistaxis, gingival or gastrointestinal bleeding) and severe hemorrhage (pulmonary or gastrointestinal bleeding) in physical examination were more frequent in serious dengue disease (p<0.01), but with poor accuracy (positive likelihood ratio=1.89 and 3.89; negative likelihood ratio=0.53 and 0.60, respectively). Serum albumin was lower in serious dengue forms (p<0.01). Despite statistical significance (p<0.05), both groups presented thrombocytopenia. Platelets count, hematocrit, and hemoglobin parameters had area under the curve <0.5. Conclusions Lethargy, abdominal distension, pleural effusion, and hypoalbuminemia were the best clinical and laboratorial markers of serious dengue disease in hospitalized children, while bleeding, severe hemorrhage, hemoconcentration and thrombocytopenia did not reach adequate diagnostic accuracy. In pediatric referral hospitals, the absence of hemoconcentration does not imply absence of plasma leakage, particularly in children with previous fluid replacement. These findings may contribute to the clinical management of dengue in children at referral hospitals.
Authors and Affiliations
Sheila Pone
Keywords
Related Articles
- EP ID EP512086
- DOI 10.1016/j.jped.2015.12.005
- Views 91
- Downloads 0
Acute kidney injury in HIV-infected children: comparison of patients according to the use of highly active antiretroviral therapy
Objective To assess clinical and laboratory data, and acute kidney injury (AKI) in HIV-infected children using and not using highly active antiretroviral therapy (HAART) prior to admission. Methods A retrospective study...
Performance of different diagnostic criteria of overweight and obesity as predictors of metabolic syndrome in adolescents
Objective To analyze the performance of three different diagnostic criteria of overweight and obesity (WHO, IOTF and Conde and Monteiro) using body mass index (BMI) as predictors of metabolic syndrome (MetS) in a represe...
Evaluation of clinical and laboratory variables associated with anemia in pediatric patients on hemodialysis
Objective To identify the occurrence of anemia in pediatric patients on hemodialysis and the association between hemoglobin levels and anemia in CKD-related variables. Methods This was a retrospective study. Patients ag...
Placental and colostral transfer of antibodies reactive with enteropathogenic Escherichia coli intimins α, β, or γ
Objective Intimins are protein adhesins of enteropathogenic Escherichia coli and enterohemorrhagic E. coli capable of inducing attachment and effacement lesions in enterocytes. Anti-intimin antibodies are important for t...
Evaluation of human milk titratable acidity before and after addition of a nutritional supplement for preterm newborns
Objective To evaluate the initial Dornic acidity in raw human milk, after pasteurization and after heating and dilution of a dietary supplement for preterm infants. Methods A quantitative, descriptive, and experimental...