{"title":"The risk factors of dengue shock syndrome among Indonesian children: A systematic review and meta-analysis","authors":"Arya Krisna Manggala , Justika Usmadhani Aulya , Jonny Karunia Fajar , Dyah Kanya Wati","doi":"10.1016/j.cegh.2025.102095","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Dengue shock syndrome (DSS) continues to have high morbidity and mortality among Indonesian children. In addition, studies on the risk factors for DSS among children, particularly in Indonesia, remain inconsistent and inconclusive. Thus, we conducted a recent systematic review and meta-analysis of the risk factors associated with DSS.</div></div><div><h3>Methods</h3><div>Published papers from PubMed, Google Scholar, <em>Garba Rujukan Digital</em> (GARUDA), and the <em>Indonesian Scientific Journal Database</em> (ISJD) assessing demographic aspects, clinical manifestations, and laboratory findings were analyzed. Pooled odds ratios (OR) or event rates with 95 % confidence intervals (CI) were estimated using fixed or random-effects models. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline.</div></div><div><h3>Results</h3><div>We included 19 studies with a total of 3086 children, reporting the event rate and the risk factors associated with DSS in children. The pooled rate showed that 36.0 % of children in Indonesia had DSS (PR 0.36 [95 % CI 0.33–0.38], p < 0.001). Pooled OR identified that obesity/overweight (OR 2.30 [95 % CI 1.51–3.48], p < 0.001), secondary dengue infection (OR 1.49 [95 % CI 1.12–1.99], p = 0.006), abdominal pain (OR 2.34 [95 % CI 1.29–4.25], p = 0.005), hepatomegaly (OR 6.31 [95 % CI 2.78–14.31], p < 0.001), ascites (OR 9.56 [95 % CI 6.27–14.59], p < 0.001), pleural effusion (OR 9.15 [95 % CI 3.18–26.29], p < 0.001), gastrointestinal tract (GI) bleeding (OR 5.15 [95 % CI 1.87–14.13], p = 0.001), increased hematocrit (OR 4.65 [95 % CI 2.95–7.34], p < 0.001), thrombocytopenia (OR 3.21 [95 % CI 1.81–5.69], p < 0.001), and elevated aspartate aminotransferase (AST) levels (OR 7.42 [95 % CI 4.02–13.69], p < 0.001) were significant risk factors associated with DSS in children.</div></div><div><h3>Conclusion</h3><div>Obesity/overweight, secondary dengue infection, abdominal pain, hepatomegaly, ascites, pleural effusion, gastrointestinal tract bleeding, increased hematocrit, thrombocytopenia, and elevated AST levels were identified as risk factors for DSS among Indonesian children.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"34 ","pages":"Article 102095"},"PeriodicalIF":1.7000,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Epidemiology and Global Health","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2213398425001848","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Dengue shock syndrome (DSS) continues to have high morbidity and mortality among Indonesian children. In addition, studies on the risk factors for DSS among children, particularly in Indonesia, remain inconsistent and inconclusive. Thus, we conducted a recent systematic review and meta-analysis of the risk factors associated with DSS.
Methods
Published papers from PubMed, Google Scholar, Garba Rujukan Digital (GARUDA), and the Indonesian Scientific Journal Database (ISJD) assessing demographic aspects, clinical manifestations, and laboratory findings were analyzed. Pooled odds ratios (OR) or event rates with 95 % confidence intervals (CI) were estimated using fixed or random-effects models. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline.
Results
We included 19 studies with a total of 3086 children, reporting the event rate and the risk factors associated with DSS in children. The pooled rate showed that 36.0 % of children in Indonesia had DSS (PR 0.36 [95 % CI 0.33–0.38], p < 0.001). Pooled OR identified that obesity/overweight (OR 2.30 [95 % CI 1.51–3.48], p < 0.001), secondary dengue infection (OR 1.49 [95 % CI 1.12–1.99], p = 0.006), abdominal pain (OR 2.34 [95 % CI 1.29–4.25], p = 0.005), hepatomegaly (OR 6.31 [95 % CI 2.78–14.31], p < 0.001), ascites (OR 9.56 [95 % CI 6.27–14.59], p < 0.001), pleural effusion (OR 9.15 [95 % CI 3.18–26.29], p < 0.001), gastrointestinal tract (GI) bleeding (OR 5.15 [95 % CI 1.87–14.13], p = 0.001), increased hematocrit (OR 4.65 [95 % CI 2.95–7.34], p < 0.001), thrombocytopenia (OR 3.21 [95 % CI 1.81–5.69], p < 0.001), and elevated aspartate aminotransferase (AST) levels (OR 7.42 [95 % CI 4.02–13.69], p < 0.001) were significant risk factors associated with DSS in children.
Conclusion
Obesity/overweight, secondary dengue infection, abdominal pain, hepatomegaly, ascites, pleural effusion, gastrointestinal tract bleeding, increased hematocrit, thrombocytopenia, and elevated AST levels were identified as risk factors for DSS among Indonesian children.
背景登革热休克综合征(DSS)在印度尼西亚儿童中仍然具有很高的发病率和死亡率。此外,特别是在印度尼西亚,关于儿童中DSS风险因素的研究仍然不一致和没有定论。因此,我们最近对与DSS相关的危险因素进行了系统回顾和荟萃分析。方法分析PubMed、谷歌Scholar、Garba Rujukan Digital (GARUDA)和印度尼西亚科学期刊数据库(ISJD)发表的关于人口统计学、临床表现和实验室结果的论文。使用固定或随机效应模型估计合并优势比(OR)或95%置信区间(CI)的事件发生率。本研究是根据系统评价和荟萃分析的首选报告项目(PRISMA)指南进行的。结果我们纳入了19项研究,共3086名儿童,报告了儿童DSS的发生率和相关危险因素。合并率显示,印度尼西亚有36.0%的儿童患有DSS (PR = 0.36 [95% CI = 0.33-0.38], p <;0.001)。合并OR确定肥胖/超重(OR 2.30 [95% CI 1.51-3.48], p <;0.001),继发性登革热感染(OR 1.49 [95% CI 1.12-1.99], p = 0.006),腹痛(OR 2.34 [95% CI 1.29-4.25], p = 0.005),肝肿大(OR 6.31 [95% CI 2.78-14.31], p <;0.001)、腹水(或9.56 (95% CI 6.27 - -14.59), p & lt;0.001),胸腔积液(OR 9.15 [95% CI 3.18-26.29], p <;0.001),胃肠道(GI)出血(OR 5.15 [95% CI 1.87-14.13], p = 0.001),红细胞压积升高(OR 4.65 [95% CI 2.95-7.34], p <;0.001),血小板减少症(OR 3.21 [95% CI 1.81-5.69], p <;0.001),谷草转氨酶(AST)水平升高(OR 7.42 [95% CI 4.02-13.69], p <;0.001)是与儿童DSS相关的显著危险因素。结论肥胖/超重、继发性登革热感染、腹痛、肝肿大、腹水、胸腔积液、胃肠道出血、红细胞比容增加、血小板减少和AST水平升高是印尼儿童DSS的危险因素。
期刊介绍:
Clinical Epidemiology and Global Health (CEGH) is a multidisciplinary journal and it is published four times (March, June, September, December) a year. The mandate of CEGH is to promote articles on clinical epidemiology with focus on developing countries in the context of global health. We also accept articles from other countries. It publishes original research work across all disciplines of medicine and allied sciences, related to clinical epidemiology and global health. The journal publishes Original articles, Review articles, Evidence Summaries, Letters to the Editor. All articles published in CEGH are peer-reviewed and published online for immediate access and citation.