A multicenter study of clinical presentations and predictive factors for severe manifestation of dengue in adults

Background: Early recognition of severe manifestation of dengue would decrease morbidity and mortality. Our objectives were to determine clinical presentations of adults with dengue and to identify predictive factors for severe manifestation of dengue.

Methods: A retrospective cohort study was performed in adults with dengue confirmed by positive NS1 antigen between January 2013 and July 2015. Patients were classified into non-severe manifestation of dengue and severe manifestation of dengue (dengue hemorrhagic fever and dengue shock syndrome). Logistic regression analysis was used to determine predictive factors for severe manifestation of dengue.

Results: A total of 357 patients were enrolled and 45.4% patients were males with median (inter-quartile range, IQR) age of 27.9 (21.8-43.5) years. Fever (99.7%) was the most common presentation with median duration of 3 (2-4) days. Other presentations included myalgia (62.1%), headache (52.7%) and nausea/vomiting (50.7%). Of 349 patients, 282 (80.8%) patients had non-severe manifestation of dengue and 67 (19.2%) patients had severe manifestation of dengue. Patients with severe manifestation of dengue had significantly older age [34.5 (24.0-53.0) vs. 26.5 (21.7-39.7) years, p=0.003], longer median duration of fever [4 (3-5) vs. 3 (2-4) days, p=0.003], higher proportion of having petechiae (14.9 vs. 6.4%, p=0.021), hepatomegaly (9.0 vs. 2.8%, p=0.022) and underlying disease (28.4 vs. 11.7%, p=0.001). At the first hospital visit, patients with severe manifestation of dengue showed significantly lower platelet counts [57 (37-76) vs. 137 (93.5-172.5) x 10³/cumm, p <0.001], higher alanine aminotransferase [129 (62-237) vs. 57.5 (32-100) U/L, p <0.001] and lower albumin [3.4 (3.2-3.8) vs. 4 (3.6-4.2) g/L, p <0.001]. By multivariate analysis, platelet counts <100 x 10³/cumm [odds ratio (OR) 12.99, 95% confidence interval (CI) 3.11-54.18, p <0.001] and serum albumin <3.5 g/L (OR 8.99; 95% CI 2.53-31.88, p=0.001) were significant predictors for severe manifestation of dengue.

Conclusion: Severe manifestation of dengue was observed in approximately 20% of adults with dengue. Low levels of platelet counts and serum albumin were predictive factor for severe manifestation of dengue in Thai adults.