Evaluation of the traditional and revised WHO classifications of Dengue disease severity.
Evaluation of the traditional and revised WHO classifications of Dengue disease severity.
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DOI：
10.1371/journal.pntd.0001397
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发表时间：
2011-11
影响因子：
3.8
通讯作者：
Harris E
中科院分区：
文献类型：
--
作者：
Narvaez F;Gutierrez G;Pérez MA;Elizondo D;Nuñez A;Balmaseda A;Harris E
登革热是世界范围内的一个主要公共卫生问题，发病率在不断增加。登革热病毒（DENV）感染可导致一系列后果，包括亚临床感染、未分化发热性疾病、登革热（DF）、危及生命的综合征，包括失水和低血压性休克，或出血和器官衰竭等其他严重表现。世界卫生组织（WHO）长期存在的登革热分类和管理方案最近进行了修订，将登革热、登革出血热（DHF）和登革休克综合征（DSS）替换为无警告迹象的登革热、有警告迹象的登革热（腹痛、持续呕吐、液体积聚、粘膜出血、嗜醒、肝脏增大、红细胞压积增加和血小板减少）和严重登革热(SD；伴有严重血浆渗漏、大出血或器官衰竭的登革热)。我们利用尼加拉瓜马那瓜一项以医院为基础的儿童登革热研究的5年（2005-2010年）数据，根据临床干预水平评估了传统和修订后的分类方案，以确定每种方案如何捕捉疾病严重程度。实验室确诊的登革热病例（544例）采用分类方案和按护理水平（I-III级）进行分类。第一类是门诊治疗，第二类是不符合第三类标准的住院治疗，包括ICU入院、通气、使用肌力药物或器官衰竭。捕获DHF/DSS III类护理的敏感性和特异性分别为39.0%和75.5%；SD的敏感性和特异性分别为92.1%和78.5%。在该数据集中，DENV-2被发现与DHF/DSS显著相关；然而，在修订后的分类中没有观察到这种关联。在登革热确诊病例中，世卫组织修订的重症登革热分类似乎在确定需要加强护理的病例方面具有更高的敏感性和特异性，尽管它不再像传统模式那样针对特定致病实体具有特异性。登革热是一种由蚊子传播的病毒性疾病，是全球主要的公共卫生问题。登革热病毒（DENV）感染可导致登革热（DF）和一系列危及生命的综合征，包括失水和低血压休克或其他严重症状。最近，世界卫生组织（WHO）传统的登革热分类方案（经典登革热、登革出血热（DHF）和登革休克综合征（DSS））被无警告信号的登革热、有警告信号的登革热和严重登革热（SD）所取代。利用在尼加拉瓜马那瓜一项基于医院的儿科登革热研究中收集的544例实验室确诊登革热病例的数据，我们根据临床干预水平（I-III）评估了传统和修订后的分类方案，以确定每种方案如何捕捉疾病严重程度。DHF/DSS的敏感性和特异性分别为39.0%和75.5%，SD的敏感性和特异性分别为92.1%和78.5%。有趣的是，DENV-2与DHF/DSS显著相关；然而，在修订后的分类中没有观察到这种关联。这项研究表明，在登革热确诊病例中，经修订的世卫组织分类似乎在确定需要加强护理的病例方面具有更高的敏感性和特异性，尽管它不再像传统模式那样针对特定致病实体具有特异性。
Dengue is a major public health problem worldwide and continues to increase in incidence. Dengue virus (DENV) infection leads to a range of outcomes, including subclinical infection, undifferentiated febrile illness, Dengue Fever (DF), life-threatening syndromes with fluid loss and hypotensive shock, or other severe manifestations such as bleeding and organ failure. The long-standing World Health Organization (WHO) dengue classification and management scheme was recently revised, replacing DF, Dengue Hemorrhagic Fever (DHF), and Dengue Shock Syndrome (DSS) with Dengue without Warning Signs, Dengue with Warning Signs (abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, liver enlargement, increasing hematocrit with decreasing platelets) and Severe Dengue (SD; dengue with severe plasma leakage, severe bleeding, or organ failure). We evaluated the traditional and revised classification schemes against clinical intervention levels to determine how each captures disease severity using data from five years (2005–2010) of a hospital-based study of pediatric dengue in Managua, Nicaragua. Laboratory-confirmed dengue cases (n = 544) were categorized using both classification schemes and by level of care (I–III). Category I was out-patient care, Category II was in-patient care that did not meet criteria for Category III, which included ICU admission, ventilation, administration of inotropic drugs, or organ failure. Sensitivity and specificity to capture Category III care for DHF/DSS were 39.0% and 75.5%, respectively; sensitivity and specificity for SD were 92.1% and 78.5%, respectively. In this data set, DENV-2 was found to be significantly associated with DHF/DSS; however, this association was not observed with the revised classification. Among dengue-confirmed cases, the revised WHO classification for severe dengue appears to have higher sensitivity and specificity to identify cases in need of heightened care, although it is no longer as specific for a particular pathogenic entity as was the traditional schema. Dengue is a mosquito-transmitted viral disease that is a major public health problem worldwide. Dengue virus (DENV) infection leads to Dengue Fever (DF) and a spectrum of life-threatening syndromes with fluid loss and hypotensive shock or other severe manifestations. Recently, the traditional World Health Organization (WHO) dengue classification scheme (classic DF, Dengue Hemorrhagic Fever (DHF), and Dengue Shock Syndrome (DSS)) was replaced with Dengue without Warning Signs, Dengue with Warning Signs and Severe Dengue (SD). Using data from 544 laboratory-confirmed dengue cases recruited over five years of a hospital-based study of pediatric dengue in Managua, Nicaragua, we evaluated the traditional and revised classification schemes against clinical intervention levels (I–III) to determine how each captures disease severity. The sensitivity and specificity to capture Category III care for DHF/DSS were 39.0% and 75.5%, respectively, and for SD were 92.1% and 78.5%, respectively. Interestingly, DENV-2 was significantly associated with DHF/DSS; however, this association was not observed with the revised classification. This study indicates that among dengue-confirmed cases, the revised WHO classification appears to have higher sensitivity and specificity for identifying cases in need of heightened care, although it is no longer as specific for a particular pathogenic entity as was the traditional schema.
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影响因子：
3.3
作者：
Bandyopadhyay, Shibani;Lum, Lucy C. S.;Kroeger, Axel
通讯作者：
Kroeger, Axel
DOI：
10.1016/s0035-9203(99)90027-5
发表时间：
1999-05-01
影响因子：
2.2
作者：
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通讯作者：
Seth, V
影响因子：
4.3
作者：
Lucas, G. N.;Amerasinghe, A.;Sriranganathan, S.
通讯作者：
Sriranganathan, S.
影响因子：
1.9
作者：
LANDIS, JR;KOCH, GG
通讯作者：
KOCH, GG
影响因子：
2.8
作者：
FERNANDEZ, RJ;VAZQUEZ, S
通讯作者：
VAZQUEZ, S