Predictors of severe dengue amongst children as per the revised WHO classification
Predictors of severe dengue amongst children as per the revised WHO classification
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DOI：
10.4103/0972-9062.318312
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发表时间：
2021-10-01
影响因子：
0.5
通讯作者：
Singh, Dhirendra Pratap
中科院分区：
文献类型：
--
作者：
Arora, Shilpa Khanna;Nandan, Devki;Singh, Dhirendra Pratap
背景和目标：世界卫生组织（WHO）于2009年修订了登革热的分类和管理指南。该修订后的系统被发现具有良好的敏感性和阴性预测值，但特异性和阳性预测值较差。方法：这项回顾性研究是在印度德里的一家三级医院进行的，旨在根据修订后的分类评估预测儿童严重登革热发生的因素。 2015年，该院共收治登革热疑似病例647例，记录并统计170例经NS1抗原检测或血清学检查（Ig M阳性）确诊为登革热患者的详细临床和流行病学资料。结果：实验室确诊病例数为170例，其中登革热（DF）30例（17.65%）、106例。 (62.35%) 具有警告症状的登革热 (DWS) 和 34 名 (20.0%) 严重登革热 (SD) 患者。回归分析显示，呕吐、感觉改变、休克、眶周水肿、肝肿大、脾肿大、严重贫血、血小板减少、尿素和肌酐升高、总蛋白和球蛋白下降与严重疾病的发生显着相关。 解读与结论：增加临床特征（眶周水肿和脾肿大）；实验室检查结果（尿素和肌酐升高、血清蛋白和球蛋白降低）可能有助于提高修订后的世界卫生组织登革热分类在预测严重登革热方面的敏感性和特异性。
Background & objectives: World Health Organization (WHO) revised its guidelines for classification and management of dengue in 2009. This revised system was found out to have good sensitivity and negative predictive value but poor specificity as well as positive predictive value.Methods: This retrospective study was carried out in a tertiary care hospital of Delhi, India to assess factors predicting the occurrence of severe dengue in children as per the revised classification. A total of 647 suspected dengue cases were admitted in the hospital in the year 2015. Detailed clinical and epidemiological data of 170 patients who were confirmed as dengue either by NS1 antigen test or by serology (Ig M positive) were recorded and statistically analyzed.Results: The number of laboratory-confirmed cases was 170 and included thirty (17.65%) dengue fever (DF), 106 (62.35%) dengue with warning signs (DWS) and 34 (20.0%) severe dengue (SD) patients. Regression analysis revealed that presence of vomiting, altered sensorium, shock, peri-orbital edema, hepatomegaly, splenomegaly, severe anemia, thrombocytopenia, elevated urea and creatinine, decreased total protein and globulin were significantly associated with occurrence of severe disease.Interpretation & conclusion: The addition of clinical features (peri-orbital edema and splenomegaly); and laboratory findings (elevated urea and creatinine, decreased serum protein and globulin) might help improve the sensitivity and specificity of the revised WHO dengue classification in predicting severe dengue.