Outcome of dengue infection and risk factors for severe dengue in Indian children.

Abstract

Background objectives: Dengue, a fast-growing vector-borne disease, has an estimated case- fatality rate of 5%. India is largely affected by dengue. Due to its unpredictable course and non-availability of specific treatment, timely identification of risk factors for severe dengue and its management is crucial. This study aimed to evaluate the clinical profile of children admitted to a tertiary care hospital with dengue, including their outcome, and identify the risk factors for severe dengue.

Methods: This prospective observational study included children admitted with serologically confirmed dengue. World Health Organization classification was used to classify the illness. The details of demographic characteristics, history, clinical examination, laboratory parameters, and outcome were noted. Various risk factors, associated with severe dengue including clinical and laboratory parameters, were determined using crude and adjusted odds ratios at 95% CI.

Results: Out of 157 enrolled children, 51 (32.5%) had severe dengue, and 5 (3.2%) died. Severe dengue showed no predilection for age, gender, and baseline IgG positivity. Multivariate- logistic regression analysis identified only fever ≥39°C [aOR 4.06 (1.60-10.27)] and petechiae [aOR 9.91(3.07-32.03)] as the clinical risk factors for severe dengue. Prolonged prothrombin time (>14s) [aOR 37.21(1.46-946.23)] and platelet count less than 50,000/cu mm [aOR 12.83(1.12-147.17] were observed as independent laboratory risk factors for severe dengue.

Interpretation conclusion: Simple clinical measures like a detailed history of fever >39°C and examination, especially for petechiae, should caution clinicians against progressing to severe dengue. Along with platelet count, prothrombin time should also be monitored during the laboratory investigations.