Publication: Identification of clinical factors associated with severe dengue among Thai adults: a prospective study
Issued Date
2015
Valid Date
2017-11-08
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eng
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Mahidol University
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BioMed Central
Bibliographic Citation
BMC Infectious Diseases. Vol.15, (2015), 420
Suggested Citation
Vipa Thanachartwet, Nittha Oer-areemitr, Supat Chamnanchanunt, Duangjai Sahassananda, Akanitt Jittmittraphap, Plengsakoon Suwannakudt, Varunee Desakorn, Anan Wattanathum Identification of clinical factors associated with severe dengue among Thai adults: a prospective study. BMC Infectious Diseases. Vol.15, (2015), 420. doi:10.1186/s12879-015-1150-2 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/3078
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Title
Identification of clinical factors associated with severe dengue among Thai adults: a prospective study
Abstract
Background: Dengue is the most common mosquito-borne viral disease in humans. Recently, there has been an
epidemic shift of dengue from mainly affecting children to affecting more adults with increased severity. However,
clinical factors associated with severe dengue in adults have varied widely between studies. We aimed to identify
the clinical factors associated with the development of severe dengue according to the World Health Organization
(WHO)’s 2009 definition.
Methods: We conducted a prospective study of adults with dengue admitted to the Hospital for Tropical Diseases
in Bangkok, Thailand, from October 2012 to December 2014. Univariate and stepwise multivariate logistic regression
analyses were performed.
Results: Of the 153 hospitalized patients with confirmed dengue viral infections, 132 (86.3 %) patients had non-severe
dengue including dengue without warning signs (7 patients, 5.3 %) and dengue with warning signs (125, 94.7 %). The
rest (21, 13.7 %) had severe dengue including severe plasma leakage (16, 76.2 %), severe organ involvement (16, 76.2 %),
and severe clinical bleeding (8, 38.1 %). Using stepwise multivariate logistic regression, clinical factors identified
as independently associated with the development of severe dengue were: (1) being >40 years old (odds ratio [OR]:
5.215, 95 % confidence interval [CI]: 1.538–17.689), (2) having persistent vomiting (OR: 4.817, CI: 1.375–16.873),
(3) having >300 cells per μL of absolute atypical lymphocytes (OR: 3.163, CI: 1.017–9.834), and (4) having lactate levels
≥2.0 mmol/L (OR: 7.340, CI: 2.334–23.087). In addition, increases in lactate and absolute atypical lymphocyte levels
corresponded with severe dengue (p < 0.05).
Conclusions: Our study identified several clinical factors independently associated with the development of severe
dengue among hospitalized adults with dengue. This can aid in the early recognition and prompt management
of at-risk patients to reduce morbidity and mortality.