Clinical features of dengue hemorrhagic fever and risk factors of shock event

Abstract

Background Dengue hemorrhagic fever (DHF) can lead to high morbidity and mortality. Its clinical features vary from time to time. Many studies were performed to determine the risk factors of se- vere dengue infection. Objective To find out clinical features and risk factors for predict- ing the likelihood of shock in DHF. Methods A retrospective cohort study was conducted in all con- firmed DHF children who were hospitalized at the Department of Child Health, Cipto Mangunkusumo Hospital within the period of January 1, 2003 until June 30, 2004. Risk factors for development of shock were analyzed using chi-square test and multiple logistic regressions with a level of significance of <0.05. Results A total of 101 patients, consisted of 47 males and 54 females were enrolled in this study. Mean age was 6.5 (SD 3.6) years, ranged from 5 months to 15 years. About 31.7% patients had grade III DHF, 30.7% grade II, and 26.7% grade IV (including 1 patient with encephalopathy). Shock was more frequent among patients aged between 6-10 years, female, under-nourished, body temperature <38°C, hematocrit level 46-50 vol%, and platelet count <20 000/ml. During year 2003-2004, there was increased number of patients who developed shock. Based on univariate analysis, hepatomegaly, high hematocrit value, and thrombocytopenia were considered significantly different. Among those variables analyzed with multiple logistic regression method, only hepatomegaly and thrombocytopenia were identified as predictors of shock. Conclusion There was an alteration on clinical features of DHF in our hospital in 2003-2004 period compared to the previous years. Hepatomegaly and platelet count <50 000/ml are independent risk factors of shock among DHF patients

Keywords

• Dengue hemorrhagic fever in children
• clinical features
• risk factor
• dengue shock syndrome