Clinical characteristics and laboratory parameters in differentiating pediatric Dengue fever and Dengue hemorrhagic fever

Abstract

OBJECTIVE: The mortality of dengue hemorrhagic fever (DHF) infection in children is still high. Discriminating dengue fever (DF) and DHF during the early phase is difficult, especially with limited diagnostic tools in peripheral areas. Hence, early identification of significant factors in DHF is important, with rapid disease progression may lead to mortality. This study aims to determine early clinical and laboratory parameters significant in differentiating DF and DHF. MATERIALS AND METHODS: This is a cross-sectional study using secondary data from medical records collected by purposive sampling from January 2015 to December 2020. This study included children aged 0-18 years old diagnosed with DF and DHF based on World Health Organization (WHO) 2011 criteria. RESULTS: From multivariate analysis of 528 dengue patients, presence of prior dengue infection (OR =7.1; 95% CI: 2.1-23.7, p=0.001), transfusion administration (OR = 34; 95% CI: 8.7-132, p<0.001), present hepatomegaly (OR = 7.2; 95% CI 1.3-38.2, p=0.02) and other bleeding manifestations (OR = 3.5; 95% CI 1.3-9.3, p=0.012) are significant parameters to differentiate DF and DHF with good quality of discrimination (AUC value = 0.83) and the model is a good fit (Hosmer-Lemeshow value = 0.65). ROC analysis showed two significant variables yielded 55.6% of sensitivity and 86.3% of specificity. CONCLUSIONS: Two or more characteristics of present hepatomegaly, other bleeding manifestations, transfusion received, and prior dengue infection are specific to dengue infections yet less sensitive to differentiate DF and DHF.

Keywords

• dengue fever
• dengue hemorrhagic fever
• clinical characteristics
• children.