Risk factors influencing severity in pediatric dengue infection

ABSTRACT

Background: Dengue disease encompasses a wide spectrum of clinical presentations. While the severity of dengue disease can vary from patient to patient, it is, however, still unclear as to what factors determine dengue disease severity.Objective: To analyze the potential risk factors such as sex, age, nutritional status, dengue serotypes, D-dimer positivity, and serologic responses, and study their correlation with the severity of dengue virus infection.Methods: Dengue patients at King Chulalongkorn Memorial Hospital were enrolled for the study. Dengue serotype was determined by PCR and primary or secondary infection was determined based on serological criteria. D-dimer levels were also tested using a rapid semiquantitation system. Clinical data such as age, body weight, sex, and nutritional status were also collected.Results: Forty-six patients were confirmed for dengue fever (DF), and 52 patients were confirmed for Dengue hemorrhagic fever (DHF). 77.5% of patients had secondary dengue infection, 11.3% had primary infection, and 11.2% were of inconclusive status. Gender and age of patients did not correlate with dengue disease severity (p \> 0.05). It was inconclusive as to whether nutritional status was a risk factor. Positivity of the D-dimer test was statistically significant for DHF (p=0.001). Early increasing D-dimer in the febrile stage could predict severity of dengue infection during the initial stage of the disease (positive predictive value=68.4 %).Conclusion: D-dimer is significantly correlated with dengue severity and it may be one of the prognostic factors for dengue infection in children.