1753. Predictors of Dengue Hemorrhagic Fever in Adult Patients with Dengue Virus Infection
Session: Poster Abstract Session: Viral Infections; Pathogenesis and Epidemiology
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • Poster ID Week 2013.pdf (156.0 kB)
  • Background: Dengue virus infection has become an emerging infectious disease worldwide and increasingly occurs in adults. Dengue virus infection is a systemic disease, has dynamic change in clinical phase, and appears to be difficult to predict clinical evolution. Dengue hemorrhagic fever (DHF) is a life-threatening clinical condition of dengue fever (DF). This study aimed to determine predictors of DHF in adult patients presented with DF.

    Methods: A case-control study was conducted among adult patients presented with dengue viral infection in a medical-school hospital in Bangkok, Thailand, during 2005-2012. Patients were categorized into DF group and DHF group using case definition of WHO dengue classification 1997. Clinical and laboratory parameters were compared between the two groups from day 2 to day 6 of fever.

    Results: Of 197 patients, 111 were in DF group and 86 were in DHF group. The median (range) age was 23 (15-71) years old. DHF group had significantly older median age (28 vs. 21 years, p < 0.001) and a higher proportion of female gender (64% vs. 40.5%, p = 0.002) than DF group. There were no differences in baseline hematocrit, maximum hematocrit, white blood cell (WBC) counts, and day out of fever between the two groups (p > 0.05). Platelet counts were significantly different between the two groups from fever day 3 to fever day 6, in which platelet count in DHF group was lower than DF group (p < 0.05). Liver function test revealed that alanine transaminase (ALT) level at fever day 4 was significantly higher in DHF group (140 vs. 76 U/L, p = 0.008). From multivariate analysis of factors associated with DHF, we identified 4 independent predicting factors for DHF: age > 25 years [adjusted odd ratios (OR) 6.513; 95% confidence interval (CI), 1.110 - 38.203, p = 0.032], female gender [adjusted OR 7.669; 95% CI, 1.388 - 42.362, p =  0.019], platelet at fever day 3 < 100,000/mm3 [adjusted OR 3.807; 95% CI, 1.311 - 11.058, p = 0.014], and ALT at fever day 4 > 120 IU/L [adjusted OR 13.557; 95% CI, 2.241 - 82.252, p = 0.005].

    Conclusion: DHF is common among adult patients with dengue virus infection. We proposed four clinical predicting factors for DHF in adults. These include age > 25 years, female gender, platelet at fever day 3 < 100,000/mm3, and ALT at fever day 4 > 120 IU/L. These predictors may help clinicians to plan appropriate management for adult patients with dengue virus infection.

    Pattaranit Nernsai, MD and Somnuek Sungkanuparph, MD, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand


    P. Nernsai, None

    S. Sungkanuparph, None

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