Comparison of dengue case classification schemes and evaluation of biological changes in different dengue clinical patterns in a longitudinal follow-up of hospitalized children in Cambodia.
Comparison of dengue case classification schemes and evaluation of biological changes in different dengue clinical patterns in a longitudinal follow-up of hospitalized children in Cambodia.
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DOI：
10.1371/journal.pntd.0008603
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发表时间：
2020-09
影响因子：
3.8
通讯作者：
Sakuntabhai A
中科院分区：
文献类型：
--
作者：
Dussart P;Duong V;Bleakley K;Fortas C;Lorn Try P;Kim KS;Choeung R;In S;Andries AC;Cantaert T;Flamand M;Buchy P;Sakuntabhai A
世界卫生组织（世卫组织）于1997年和最近于2009年提出了登革热临床分类指南，用于患者的临床管理。世界卫生组织1997年的分类根据严重程度将登革热感染分为三类：登革热（DF）、登革出血热（DHF）和登革休克综合征（DSS）。世卫组织2009年替代指南提供了一种横断面分类，旨在将登革热与有警告标志的登革热（DWWS）和严重登革热（SD）区分开来。本研究的主要目的是对两种登革热分类进行比较。次要目的是描述在疾病过程中出现不同严重程度的患者中发生的血液学和生化参数的变化，因为进展为更严重的临床形式是不可预测的。我们对柬埔寨2至15岁的重症和非重症登革热住院儿童进行了前瞻性、单中心、横断面研究。我们招募了243例急性登革热样疾病患者：71.2%的登革热感染经定量逆转录PCR或NS 1抗原捕获ELISA证实，其中87.2%和9.0%的DF病例分别被分类为DWWS和SD，35.9%的DHF被指定为SD，使用适用的WHO 2009年SD病例定义分类。在患者入院时系统使用超声检查对于检测血浆泄漏至关重要。在不同登革热严重程度组之间没有观察到分泌的NS 1蛋白的浓度差异。入院时DWWS和SD之间的血脂谱不同，其特征在于SD中的总胆固醇、HDL胆固醇和LDL胆固醇降低。我们的研究结果表明，这两种分类之间的差异，包括严重的登革热病例的错误分类为轻度病例的WHO 1997年的分类。使用经过调整的WHO 2009分类，SD更精确地定义了在住院期间的给定时间需要仔细临床护理的患者组。登革热是一种病毒性疾病，导致各种健康状况，从严格的无症状感染到危及生命的严重登革热。在这里，我们比较了1997年和2009年世界卫生组织（WHO）的两个登革热分类方案，它们定义了不同类别的登革热，并且一直是登革热研究界争论的根源。我们招募了一个柬埔寨儿科队列的住院登革热确诊患者，并进行了临床和生物学随访。我们的研究结果表明，（i）WHO 1997分类是一种纵向登革热病例分类，它使用严格的先决条件临床和/或生物学体征从一个严重程度水平转移到另一个严重程度，（ii）WHO 2009分类是一种横向登革热病例分类，更灵活，并且当与系统地使用超声波相适应时，在识别严重登革热病例以及时和适当地对住院患者进行临床管理方面更准确。我们的实验室结果发现，血脂谱在医院不同登革热严重程度组之间表现出变化和差异。
The World Health Organization (WHO) proposed guidelines on dengue clinical classification in 1997 and more recently in 2009 for the clinical management of patients. The WHO 1997 classification defines three categories of dengue infection according to severity: dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). Alternative WHO 2009 guidelines provide a cross-sectional classification aiming to discriminate dengue fever from dengue with warning signs (DWWS) and severe dengue (SD). The primary objective of this study was to perform a comparison of two dengue classifications. The secondary objective was to describe the changes of hematological and biochemical parameters occurring in patients presenting with different degrees of severity during the course of the disease, since progression to more severe clinical forms is unpredictable. We performed a prospective, monocentric, cross-sectional study of hospitalized children in Cambodia, aged from 2 to 15 years old with severe and non-severe dengue. We enrolled 243 patients with acute dengue-like illness: 71.2% were dengue infections confirmed using quantitative reverse transcription PCR or NS1 antigen capture ELISA, of which 87.2% and 9.0% of DF cases were respectively classified DWWS and SD, and 35.9% of DHF were designated SD using an adapted WHO 2009 classification for SD case definition. Systematic use of ultrasound at patient admission was crucial for detecting plasma leakage. No difference was observed in the concentration of secreted NS1 protein between different dengue severity groups. Lipid profiles were different between DWWS and SD at admission, characterized by a decrease in total cholesterol, HDL cholesterol, and LDL cholesterol, in SD. Our results show discrepancies between the two classifications, including misclassification of severe dengue cases as mild cases by the WHO 1997 classification. Using an adapted WHO 2009 classification, SD more precisely defines the group of patients requiring careful clinical care at a given time during hospitalization. Dengue is a viral disease that results in various health conditions, ranging from strictly asymptomatic infections to life-threatening severe dengue. Here we have compared the two World Health Organization (WHO) dengue classification schemes from 1997 and 2009, which define different categories of dengue fever and have been at the root of much debate in the dengue research community. We enrolled a Cambodian pediatric cohort of hospitalized dengue-confirmed patients, with clinical and biological follow-up. Our findings demonstrate that (i) the WHO 1997 classification is a longitudinal dengue-case classification which uses strict prerequisite clinical and/or biological signs to move from one level of severity to another, and (ii) the WHO 2009 classification, being a transversal dengue-case classifier, is more flexible and when adapted with systematic use of ultrasound is more accurate in identifying severe dengue case for timely and appropriate clinical management of hospitalized patients. Our laboratory results found that lipid profiles exhibited changes and differences between different dengue severity groups at hospital.
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影响因子：
3.3
作者：
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影响因子：
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DOI：
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