FACTORS ASSOCIATED WITH SEVERITY OF ILLNESS IN PATIENTS WITH DENGUE FEVER IN A TERTIARY CARE HOSPITAL IN SOUTHERN INDIA

Melissa Sherrel Pereira; Chandrashekar Udyavara Kudru; Sreedharan Nair; Girish Thunga; Vijayanarayana Kunhikatta; Vasudeva Guddattu

doi:10.22159/ajpcr.2018.v11i3.23496

Authors

Melissa Sherrel Pereira Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, India.
Chandrashekar Udyavara Kudru Department of Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
Sreedharan Nair Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, India.
Girish Thunga Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, India.
Vijayanarayana Kunhikatta Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, India.
Vasudeva Guddattu Department of Statistics, Manipal University, Manipal, Karnataka, India.

DOI:

https://doi.org/10.22159/ajpcr.2018.v11i3.23496

Keywords:

Dengue infection, Flavivirus, Plasma leakage, Severe dengue

Abstract

Â Objective: Denguefeveris one of the important tropical disease of public health significance caused by flavivirus. It is a major cause of morbidity and mortality worldwide. Identification of factors associated with severity of dengue can improve the prognosis of the disease.This study tried toassess the factors associated with severity of dengue.

Methods: A record based study was conducted in a tertiary care hospital setting in southern India. A total of 550 case files were reviewed to ascertain demographic, clinical and laboratory parameters among confirmed cases of dengue. The severity of dengue was categorized using WHO 2009 classification.

Results: Of 550 records reviewed, 449 (81.6%) were classified as non-severe dengue and 101 (18.4%) as severe dengue. Factors associated with severe dengue on univariate analysis were: gender, backache, skin rash, nausea and vomiting, abdominal distension, haemorrhage, breathlessness, oliguria, hepatomegaly, splenomegaly, ascites, leukopenia, hypoproteinemia, and elevated serum alanine transaminase (ALT) >63 IU/L.On multivariate analysis,haemorrhage (OR=11.75, 95%; CI=6.38-21.62), oliguria (OR=4.01, 95%; CI=1.32-12.15), ascites (OR=2.68, 95%; CI=1.19-6.01), ALT>63 IU/L (OR=1.77, 95%; CI=1.01-3.1) and hypoproteinemia (OR=5.57, 95%; CI=2.82-10.98) were found to have significant association with the development of severe dengue.

Conclusion: This study indicates thatwhen dengue patients present with bleeding episodes, ascites, oliguria,raised ALT and low serum protein levels, clinicians should be alert to the appearance of severe complications. Early identification of these factors will help clinicians to recognise the severity of dengue illness and enable them to implement appropriate interventions.

Downloads

Download data is not yet available.

References

WHO. Dengue: Guidelines for diagnosis, treatment, prevention and control, 1st ed. Geneva, World Health Organization; 2009.

WHO. Dengue and severe dengueFact sheet. World Health Organization, 2017. Available from: http://www.who.int/mediacentre/factsheets/fs117/en/. [Last accessed on 2017 Sep 06).

WHO. Global Health Estimates 2015: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2015. Geneva, World Health Organization; 2016.

Anung KL, Thanacharwet V, Desakorn V, Chamnanchanunt S, Sahassananda D, Chierakul W, et al. Factors associated with severe clinical manifestation of dengue among adults in Thailand. Southeast Asian J Trop Med Public Health2013;44(4):602-12.

Thomas L, Broustey Y, Najioullah F, Hochedez P, Hatchuel Y, Moravie V, et al. Predictors of severe manifestations in a cohort of adult dengue patients. J Clin Virol 2010;48(2):96-9.

Malavige GN, Velathanthiri VG, Wijewickrama ES, Fernando S, Jayaratne SD, Aaskov J, et al. Patterns of disease among adults hospitalized with dengue infections. QJM 2006;99(5):299-305.

Thanachartwet V, Oer-Areemitr N, Chamnanchanunt S, Sahassananda D, Jittmittraphap A, Suwannakudt P, et al. Identification of clinical factors associated with severe dengue among Thai adults: A prospective study. BMC Infect Dis 2015;15:420.

Gupta N, Srivastava S, Jain A, Chaturvedi UC. Dengue in India. Indian J Med Res 2012;136(3):373-90.

Goyal V, Gill GS, Singh J, Singh GP, Singh Y, Singh S, et al. Clinical spectrums of dengue fever in a tertiary care centre with particular references to atypical presentation in the 2011 outbreak at Bathinda, Punjab, India. Int J Pharm Pharm Sci 2013;5 Suppl 4:363-67.

Nayak J, Behera S, Swain SK, Panda SR. A study of multiorgan dysfunction in patients with dengue and its clinico-hematological correlation with severity. Asian J Pharm Clin Res 2017;10(2):218-21

Singh NP, Jhamb R, Agarwal SK, Gaiha M, Dewan R, Daga MK, et al. The 2003 outbreak of dengue fever in Delhi, India. Southeast Asian J Trop Med Public Health 2005;36(5):1174-8.

Sinha N, Gupta N, Jhamb R, Gulati S, Kulkarni AV. The 2006 dengue outbreak in Delhi, India. J Commun Dis 2008;40(4):243-8.

Chakravarti A, Arora R, Luxemburger C. Fifty years of dengue in India. Trans R Soc Trop Med Hyg 2012;106(5):273-82.

Gupta E, Dar L, Narang P, Srivastava VK, Broor S. Serodiagnosis of dengue during an outbreak at a tertiary care hospital in Delhi. J Med Res2005;121(1):36-8.

Gupta E, Dar L, Kapoor G, Broor S. The changing epidemiology of dengue in Delhi, India. Virol J 2006;3:92.

Yacoub S, Farrar J. Dengue. In: Farrar J, Hotez PJ, Junghanss T, Kang G, Lalloo D, White NJ, editors. Mansonâ€™s Tropical Diseases. 23rd ed. Elsevier; 2014. p. 162-170.

Setiawan MW, Samsi TK, Wulur H, Sugianto D, Pool TN. Dengue haemorrhagic fever: Ultrasound as an aid to predict the severity of the disease. Pediatr Radiol 1998;28(1):1-4.

Quiroz MR, Mendez GF, Ovando RKM. Clinical utility of ultrasound in the identification of dengue haemorrhagic fever. Rev Med Inst Mex Seguro Soc 2006;44(3):243-8.

Seneviratne SL, Malavige GN, de Silva HJ. Pathogenesis of liver involvement during dengue viral infections. Trans R Soc Trop Med Hyg 2006;100(7):608-14.

Falconar AK, Romero-Vivas CM. Simple prognostic criteria can definitively identify patients who develop severe versus non-severe dengue disease, or have other febrile illnesses. J Clin Med Res 2012;4(1):33-44.

Pham TB, Nguyen TH, Vu JQ, Nguyen TL, Malvy D. Predictive factors of dengue shock syndrome at the children hospital no.1, Ho-Chi-Minh City, Vietnam. Bull Soc Pathol Exot 2007;100(1):43-7.

Raza FA, Rehman Su, Khalid R, Ahmad J, Ashraf S, Iqbal M, et al. Demographic and clinico-epidemiological features of dengue fever in Faisalabad, Pakistan. PLOS One 2014;9(3):89868.

Gulati S, Maheshwari A. Atypical manifestations of dengue. Trop Med Int Health 2007;12(9):1087-95.

Leo YS, Thein TL, Fisher DA, Low JG, Oh HM, Narayanan RL, et al. Confirmed adult dengue deaths in Singapore: 5-year multi-center retrospective study. BMC Infect Dis 2011;11:123.

Trung DT, Thao Le TT, Hien TT, Hung NT, Vinh NN, Hien PT,et al. Liver involvement associated with dengue infection in adults in Vietnam. Am J Trop Med Hyg 2010;83(4):774-80.

Kuo CH, Tai DI, Chang-chien CS, Lan CK, Chiou SS, Liaw YF. Liver biochemical tests and dengue fever. Am J Trop Med Hyg 1992;47(3):265-70.

Lima EQ, Noqueira ML. Viral hemorrhagic fever- induced acute kidney injury. Semin Nephrol 2008;28(4):409-15.

Jayaratne SD, Atukorale V, Gomes L, Chang T, Wijesinghe T, Fernando S, et al. Evaluation of the WHO revised criteria for classification of clinical disease severity in acute adult dengue infection. BMC Res Notes 2012;5:645.