Can Progression to Severe Dengue in Dengue with Warning Signs Be Predicted in the Emergency Room?

Introduction: Objectives: Materials and Methods: Results: Conclusions: Dengue has become a serious public health problem in Paraguay. Knowledge of clinical or laboratory test parameters that could predict progression of the disease during assessment in emergency services could improve early identification of individuals at greater risk and optimize use of resources during epidemics. We sought to determine the clinical and laboratory test risk factors for severe dengue (SD) on admission in patients hospitalized for dengue with warning signs (DWS). We conducted a case-control study in the emergency department of the general pediatric hospital Ninos de Acosta Nu in Paraguay between February and June of 2012. Univariate analysis of clinical and laboratory test values at admission was done to identify characteristics associated with progression to severe dengue. Statistically significant variables were subjected to logistic regression analysis. We included 217 children, 57 with SD and 160 controls with a mean age of 11 years (p= 0.719). Days of illness preceding admission were similar: 3.4 versus 3.6 (p= 0.643). Severe dengue was associated with hemoconcentration and decreased platelet count (OR: 3.3, CI 95% 2.0-11.3, p= 0.027) and a history of vomiting (OR: 3.2, CI 95% 1.7-7.2, p= 0.007). Sensitivity was 26% and sensitivity 93% for hemoconcentration and platelet decrease with a PPV of 57.7% and NPV of 78%. Vomiting showed a sensitivity of 78.9% and specificity of 48.8% with a PPV of 35.4% and NPV of 78%. Extravasation occurred between the third and sixth day of illness, with a mean of 5.3 +/- 0.9. Hemoconcentration with decreased platelet count predicted a 3.3 times greater possibility of severe dengue, but its absence did not indicate that it would not occur. None of the associations allowed prediction of severe dengue at time of admission with sufficient certainty.