Plasma prothrombin time and activated partial thromboplastin time as predictors of bleeding manifestations during dengue hemorrhagic fever

Abstract

Background Massive bleeding and shock are complications of dengue hemorrhagic fever (DHF) that are associated with high mortality. Impaired hemostasis, especially coagulopathy, contributes to bleeding manifestations in DHF. Parameters such as activated partial thromboplastin time (APTT) and plasma prothrombin time (PPT) indicate the impact of coagulation system. Objective To determine the relationship between APTT and PPT levels with bleeding manifestations in DHF patients. Methods A prospective cohort study was applied to subjects diagnosed with DHF at the Infection and Tropical Diseases Division, Department of Child Health, Medical School, Udayana University, Sanglah Hospital, Denpasar, Indonesia. Laboratory tests to determine APTT and PPT were carried out on the third, fourth, and fifth day after the onset of fever. Bleeding manifestations were examined in patients during their hospital stay. Univariate and Cox regression analyses were performed to examine relationship between APTT and PPT values with bleeding manifestations in DHF patients. Results Forty-three children were enrolled in this study. There was a significant relationship between increases in APTT value with bleeding manifestations in DHF patients [RR 2.79 (95%CI 1.68 to 4.69), P <0.01]. Cox regression analysis showed that only increased APTT values correlated with bleeding manifestations [RR 2.05 (95%CI 1.92 to 3.90), P = 0.02]. Conclusion APTT values may be used as a predictor for bleeding manifestations in DHF.

Keywords

• DHF
• impaired coagulation
• bleeding
• APTT