Predictive Tools for Severe Dengue Conforming to World Health Organization 2009 Criteria
Predictive Tools for Severe Dengue Conforming to World Health Organization 2009 Criteria
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DOI：
10.1371/journal.pntd.0002972
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发表时间：
2014-07-01
影响因子：
3.8
通讯作者：
Lye, David C.
中科院分区：
文献类型：
--
作者：
Carrasco, Luis R.;Leo, Yee Sin;Lye, David C.
背景：登革热每年造成5000万人感染，在热带和亚热带地区造成巨大的疾病和经济负担。只有一部分登革热病例需要住院，而对并发症风险较大的登革热患者进行分类的预测性工具可能会优化有限的医疗资源的使用。对于世界卫生组织(WHO)2009年登革热指南提出的严重登革热(SD)，缺乏预测工具。方法：我们对2006-2008年新加坡陈德胜医院的成年登革热患者进行了回顾性研究。登革热聚合酶链式反应阳性和血清学阳性患者出现时的人口学、临床和实验室变量被用来使用通用线性模型(GLMS)预测住院后SD的发展。主要发现：预测工具与资源充足和资源有限的环境兼容-不需要实验室测量-执行可接受的乐观校正的特异度分别为29%和27%的90%的敏感性。女性、红细胞压积低于正常、入院时有腹胀、呕吐和发热的患者发生严重登革热(SD)的风险较高。较低的SD风险与更多的年龄(在一个年龄范围为27-47岁的队列中)、白细胞减少和入院时的发烧时间有关。在2009年世界卫生组织提出的警告信号中，我们发现腹痛或压痛和呕吐是合并形式的SD的预测因子。结论：在临床环境中应用这些预测工具可能会减少19%的不必要入院，允许根据结果的严重程度将稀缺的公共卫生资源分配给患者。
Background: Dengue causes 50 million infections per year, posing a large disease and economic burden in tropical and subtropical regions. Only a proportion of dengue cases require hospitalization, and predictive tools to triage dengue patients at greater risk of complications may optimize usage of limited healthcare resources. For severe dengue (SD), proposed by the World Health Organization (WHO) 2009 dengue guidelines, predictive tools are lacking.Methods: We undertook a retrospective study of adult dengue patients in Tan Tock Seng Hospital, Singapore, from 2006 to 2008. Demographic, clinical and laboratory variables at presentation from dengue polymerase chain reaction-positive and serology-positive patients were used to predict the development of SD after hospitalization using generalized linear models (GLMs).Principal findings: Predictive tools compatible with well-resourced and resource-limited settings - not requiring laboratory measurements - performed acceptably with optimism-corrected specificities of 29% and 27% respectively for 90% sensitivity. Higher risk of severe dengue (SD) was associated with female gender, lower than normal hematocrit level, abdominal distension, vomiting and fever on admission. Lower risk of SD was associated with more years of age (in a cohort with an interquartile range of 27-47 years of age), leucopenia and fever duration on admission. Among the warning signs proposed by WHO 2009, we found support for abdominal pain or tenderness and vomiting as predictors of combined forms of SD.Conclusions: The application of these predictive tools in the clinical setting may reduce unnecessary admissions by 19% allowing the allocation of scarce public health resources to patients according to the severity of outcomes.