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Indian Pediatr 2017;54: 778-780 |
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Factors Affecting Outcome in Children with
Dengue in Kolkata
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Ishita Majumdar, *Devdeep
Mukherjee, Ritabrata Kundu, Prabal Niyogi and Joydeep Das
Department of Pediatric Medicine, Institute of Child
Health, 11 Dr Biresh Guha Street, Kolkata 700017,
West Bengal, India.
Email:
[email protected]
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This observational, descriptive study
was conducted on 260 dengue patients diagnosed as per the revised 2009
WHO guidelines in a tertiary-care hospital of eastern India between June
and November 2015. Children were evaluated for clinical symptoms, signs,
and laboratory parameters. Clinical variables viz., rash,
nausea/vomiting, bleeding, oliguria, capillary leak and liver
enlargement; and laboratory variables viz., rising haemoglobin,
haematocrit, thrombocytopenia, blood urea, serum Creatinine, ALT, hypo
albuminemia and cholesterol were found to be significantly associated
with outcome.
Keywords: Clinical features, Complications,
Dengue virus.
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Children with dengue often present
late with serious complications. Most of the previous studies in
children have been done using the older WHO classification of dengue
[1,2]. We analyzed the clinic-epidemiological profile and the
determinant factors affecting outcome in children admitted to Institute
of Child Health, Kolkata between 1st June and 30th November, 2015.
This observational study on 260 children, aged 2
months to 15 years, admitted to hospital, was based on the revised WHO
2009 case definition [3]. All children were confirmed to be having
dengue by ELISA. Ethical approval was obtained from the Institute Ethics
Committee and informed written consent was obtained from the parent or
guardian. Patients were divided in three groups [3] - Dengue without
warning signs (DF), Dengue with warning signs (DWS) and Severe Dengue
(SD). Children were evaluated for clinical symptoms (Headache,
nausea/vomiting, cough, abdominal pain, bleeding, rash), signs (Oliguria,
hepatomegaly >2cm, capillary leak), pathological (Haemoglobin (Hb),
haematocrit, total leucocyte count (TLC), platelet count), biochemical
(Urea, creatinine, C-reactive protein, albumin, cholesterol, alanine
aminotransferase (ALT)) and radiological (pleural effusion/ascites from
chest X-ray/Ultrasonography) parameters. We also documented
demography, body mass index (BMI) and outcome.
Discrete variables were analyzed by Chi-Square test,
and continuous variables by ANOVA. Statistical analysis was performed on
SPSS 20.0. P value less than 0.05 was considered significant.
Final analysis was performed on 257 children as 3 of
them left against medical advice; 2 deaths were recorded during this
period. 47% were diagnosed with DF and 42% with DWS. The mean age at
presentation was 69 months. Children between 2-8 years were the most
commonly affected. Of these, 23% were positive by NS1 ELISA, 14% were
positive by IgM ELISA, 38% were positive both for NS1Ag and IgM, 21%
were positive both with IgM and IgG and 4% were positive with all NS1Ag,
IgM and IgG
Rash was present in 65% children with 75% in DF and
only 43% in SD. Only 8% had bleeding manifestation with petechiae being
most common. 28% had oliguria and 23% had capillary leak (edema, ascites
and pleural effusion) (Table I). Rash, nausea/vomiting,
bleeding, oliguria, capillary leak and liver enlargement (>2 cm) were
considered as statistically significant clinical parameters associated
with outcome, with P<0.05 similar to other studies [6-8] .
Chi-square test for trend analysis shows an inverse relationship of rash
with dengue severity (P=0.001), unlike previous studies.
TABLE I Clinical and Laboratory Parameters in Children with Dengue (N=257)
Parameters |
DF (n=121) |
DWS (n=108) |
SD (n=28) |
Total No. (%)
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*Rash
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91 (75) |
64 (59) |
12 (43) |
167 (65) |
Nausea/vomiting |
43 (35) |
64 (59) |
22 (79) |
129 (50) |
Bleeding episodes |
2 (2) |
10 (9) |
8 (29) |
20 (8) |
Oliguria |
16 (13) |
39 (36) |
16 (57) |
71 (28) |
Capillary leak |
0 |
40 (37) |
20 (71) |
60 (23) |
Ascitis |
0 |
27 (25) |
14 (50) |
41 (16) |
Pleural effusion |
0 |
14 (13) |
17 (61) |
31 (12) |
Liver enlargement >2 cm |
0 |
40 (37) |
11 (39) |
51 (20) |
$PCV
|
36.16 (3.12) |
37.54 (4.44) |
40.58 (6.4) |
37.21 (4.35) |
$Platelet count |
166137 (86306) |
133262 (75800) |
78724 (56305) |
142857 (83604) |
$Cholesterol |
107 (26) |
100 (30) |
83 (28) |
102 (29) |
$Urea |
19.9 (6.9) |
20.06 (8.4) |
30.62 (10.3) |
21.16 (10.23) |
$Creatinine |
0.35 (0.11) |
0.36 (0.12) |
0.52 (0.23) |
0.37 (0.24) |
$ALT |
42 (37) |
71 (43) |
548 (112) |
122 (596) |
$Albumin |
4.14 (0.57) |
3.79 (0.71) |
3.12 (0.68) |
3.88 (0.73) |
Values in No. (%) or $mean (SD); All P £0.001 except *P=0.002;
ALT – alanine aminotransferase; DF – dangue fever; DWS – dengue
with warning signs; SD – severe dengue. |
Rising hemoglobin and hematocrit, thrombo-cytopenia,
high urea, creatinine and ALT, hypo-albuminemia and low cholesterol were
found to be statistically significant parameters associated with outcome
(P<0.05) (Table I). Rising hematocrit and
thrombocytopenia were a predictor of outcome in dengue similar to other
studies [4,6,9]. However, thrombo-cytopenia did not predict the
occurrence of bleeding in children with dengue as shown in previous
studies [10]. Rising hematocrit is associated with albumin and
cholesterol accompanying plasma outside the vascular compartment, as
previously reported [7,8].
There were a few limitations of this study. The data
was analyzed for patients admitted only over a single season between
June and November. Isolation of the virus serotypes was also not
attempted.
Acknowledgement: Dr Arkaprabha Sau (MD PGT,
Department of Community Medicine, RG Kar Medical College and Hospital)
helped in the statistical analysis of the data.
Contributions: IM, DM: collection and
interpretation of data and drafting of manuscript; IM, DM, RK, PN, JD:
contributed to planning of study, patient management, data
interpretation and review of manuscript. The final manuscript was read
and approved by all authors.
Funding: None; Competing interest:
None stated.
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