Management of patients suspected of having dengue fever: association of Illness severity with clinical parameters: a single center experience from Southern Sri Lanka

Abstract

Introduction Dengue has been associated with significant mortality and its management is governed mainly by clinical experience and consensus of experts than evidence. This study was carried out to assess the association of disease severity and clinical parameters of patients suspected of having dengue fever. Method A retrospective descriptive study was conducted in District General Hospital (DGH), Matara using hospital data avail­able in patients’ records. A total of 1005 adult patients with fever and low platelets admitted during the months of May, June July and August 2017 were studied. Trends in white cell count (WCC), Platelets counts, haematocrit (PCV) and Platelet distribution width (PDW) were recorded. Comparisons were made between the days of the illness, drop in platelet count, rise in the PCV&WCC and change in PDW, among Dengue fever (DF) and Dengue hemorrhagic fever (DHF) patients. Correlation with disease severity with the presence of comorbidities and NS1 antigen positivity was also assessed. Results No correlation was found with disease severity and presence of comorbidities or NS1 antigen positivity. Rise in PCV & WCC and drop in platelet counts were noted with the onset of leaking phase of DHF. Conclusions Rapid drop in platelet counts appears to be the most reliable parameters to indicate the onset of leaking phase. Previously described 20% rise of PCV is not a reliable indicator of the onset of leaking in patients hospitalized in the early phase of the illness.