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A T, S CE, Badveti S, Vs KKM, Kumar V, S VSG. Clinical Profile of Dengue Seropositive Infection From a Tertiary Care Hospital Situated in Mysuru, South India. Cureus 2024; 16:e65175. [PMID: 39176322 PMCID: PMC11339719 DOI: 10.7759/cureus.65175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2024] [Indexed: 08/24/2024] Open
Abstract
Introduction Dengue, a viral infection transmitted by Aedes mosquitoes, has become a significant global health concern. Its incidence has surged dramatically over the past decades, with severe cases potentially leading to life-threatening conditions such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Despite its prevalence in tropical regions, including India, the clinical manifestations of dengue can vary widely, sometimes presenting atypically. Recent outbreaks, particularly in Northern India, underscore the urgency of understanding and managing this disease. This study focuses on the clinical and laboratory findings of hospitalized dengue fever patients from January 2022 to January 2023, aiming to provide insights for effective patient care and mortality reduction. Methods This was a prospective study at JSS (Jagadguru Sri Shivarathreeshwara) Medical College and Hospital, Mysuru, Karnataka, India (January 2022-January 2023). Blood samples from suspected dengue patients presenting acute febrile symptoms were collected. NS1 antigen and IgM antibody were detected using enzyme-linked immunosorbent assay (ELISA). Patients positive for dengue NS1 antigen and IgM antibodies were included in the study, excluding those with co-infections or comorbidities. Results A nine-month study at JSS Hospital (January 2022-January 2023) screened 1019 samples, identifying 316 dengue cases. Among these, 84.8% were dengue fever and 15.1% were DHF/DSS. Male predominance (60.1%) was noted, with peak incidence in the age groups of 11-20 years (29.11%) and 0-10 years (27.53%). Common symptoms included fever (98.1%), headache (32.91%), myalgia (40.87%), and vomiting (42.7%). Thrombocytopenia was found in 60.6% of cases. NS1 was detected in 56% of patients and IgM was positive in 20.8% of the patients. Comorbidities like type 2 diabetes mellitus (T2DM) (7.59%) and hypertension (7.27%) were observed. Among severe cases, 43.6% had platelet counts <1 lakh/cumm, and 27.5% required intravenous fluids. Seven deaths occurred, primarily in patients with comorbidities and severe dengue. Discussion and conclusion High dengue seropositivity among males (60.12%) compared to females (39.87%) was noted, possibly due to varied exposures. Patients aged 11-20 years had the highest dengue infection, with a peak in admissions during the rainy season. Thrombocytopenia (60.6%) and comorbidities like T2DM and HTN were common, with seven fatalities linked to severe dengue and comorbidities, emphasizing the need for early recognition and management to reduce mortality.
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Affiliation(s)
- Tejashree A
- Microbiology, JSS (Jagadguru Sri Shivarathreeshwara) Medical College and Hospital, JSS Academy of Higher Education, Mysuru, IND
| | - Chinchana E S
- Microbiology, JSS (Jagadguru Sri Shivarathreeshwara) Medical College and Hospital, JSS Academy of Higher Education, Mysuru, IND
| | - Satyasai Badveti
- Microbiology, JSS (Jagadguru Sri Shivarathreeshwara) Medical College and Hospital, JSS Academy of Higher Education, Mysuru, IND
| | - Krishna Karthik M Vs
- Microbiology, Gayatri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam, IND
| | - Vinay Kumar
- Microbiology, JSS (Jagadguru Sri Shivarathreeshwara) Medical College and Hospital, JSS Academy of Higher Education, Mysuru, IND
| | - Veerabhadra Swamy G S
- Microbiology, JSS (Jagadguru Sri Shivarathreeshwara) Medical College and Hospital, JSS Academy of Higher Education, Mysuru, IND
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Nguyen Tat T, Vo Hoang-Thien N, Nguyen Tat D, Nguyen PH, Ho LT, Doan DH, Phan DT, Duong YNH, Nguyen TH, Nguyen TK, Dinh HTT, Dinh TTD, Pham ATM, Do Chau V, Trinh TH, Vo Thanh L. Prognostic values of serum lactate-to-bicarbonate ratio and lactate for predicting 28-day in-hospital mortality in children with dengue shock syndrome. Medicine (Baltimore) 2024; 103:e38000. [PMID: 38669370 PMCID: PMC11049702 DOI: 10.1097/md.0000000000038000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
This study aimed to assess the clinical utility of blood lactate-to-bicarbonate (L/B) ratio, as a prognostic factor for 28-day in-hospital mortality in children with dengue shock syndrome (DSS), admitted to the pediatric intensive care unit (PICU). This single-center retrospective study was conducted at a tertiary children hospital in southern Vietnam from 2013 to mid-2022. Prognostic models for DSS mortality were developed, using a predefined set of covariates in the first 24 hours of PICU admission. Area under the curves (AUCs), multivariable logistic and Least Absolute Shrinkage and Selection Operator (LASSO) regressions, bootstrapping and calibration slope were performed. A total of 492 children with DSS and complete clinical and biomarker data were included in the analysis, and 26 (5.3%) patients died. The predictive values for DSS mortality, regarding lactate showing AUC 0.876 (95% CI, 0.807-0.944), and that of L/B ratio 0.867 (95% CI, 0.80-0.934) (P values of both biomarkers < .001). The optimal cutoff point of the L/B ratio was 0.25, while that of lactate was 4.2 mmol/L. The multivariable model showed significant clinical predictors of DSS fatality including severe bleeding, cumulative amount of fluid infused and vasoactive-inotropic score (>30) in the first 24 hours of PICU admission. Combined with the identified clinical predictors, the L/B ratio yielded higher prognostic values (odds ratio [OR] = 8.66, 95% confidence interval [CI], 1.96-38.3; P < .01) than the lactate-based model (OR = 1.35, 95% CI, 1.15-1.58; P < .001). Both the L/B and lactate models showed similarly good performances. Considering that the L/B ratio has a better prognostic value than the lactate model, it may be considered a potential prognostic biomarker in clinical use for predicting 28-day mortality in PICU-admitted children with DSS.
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Affiliation(s)
- Thanh Nguyen Tat
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
- Woolcock Institute of Medical Research, Ho Chi Minh City, Vietnam
- Faculty of Medicine, Texila American University, Georgetown, Guyana
| | | | - Dat Nguyen Tat
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
- Faculty of Medicine, Texila American University, Georgetown, Guyana
| | - Phuc Hoang Nguyen
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | - Lien Thi Ho
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | - Duong Hung Doan
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | - Dung Tuan Phan
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | | | - Truc Huynh Nguyen
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | - Tuyet Kim Nguyen
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | - Ha Thi-Thu Dinh
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | - Thuy Thi-Diem Dinh
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | - Anh Thi-Mai Pham
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | - Viet Do Chau
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | - Tung Huu Trinh
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | - Luan Vo Thanh
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
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Low GKK, Jiee SF, Masilamani R, Shanmuganathan S, Rai P, Manda M, Omosumwen OF, Kagize J, Gavino AI, Azahar A, Jabbar MA. Routine blood parameters of dengue infected children and adults. A meta-analysis. Pathog Glob Health 2023; 117:565-589. [PMID: 36593636 PMCID: PMC10392251 DOI: 10.1080/20477724.2022.2161864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The World Health Organization (WHO) has revised dengue case classification in 2009 to better reflect the severity of the disease. However, there was no comprehensive meta-analysis of pooled routine blood parameters according to the age or the categories of the 2009 WHO classification. This study aimed to meta-analyze the routine blood parameters of dengue infected children and adults. Electronic search was performed with eligible articles included for review. Meta-analysis was conducted for six blood parameters stratified into children, adults and all ages, which were further grouped into the three 2009 WHO case classifications (dengue without warning signs, DwoWS; dengue with warning signs, DwWS; severe dengue, SD), non-severe dengue (non-SD) and 'All' cases. A total of 55 articles were included in the meta-analysis. Fifteen studies were conducted in the children's age category, 31 studies in the adult category and nine studies in all ages. The four selected pooled blood parameters for children were white blood cell (WBC) (×103/L) with 5.11 (SD), 5.64 (DwWS), 5.52 (DwoWS) and 4.68 (Non-SD) hematocrit (HCT) (%) with 36.78 (SD), 40.70 (DwWS), 35.00 (DwoWS) and 29.78 (Non-SD) platelet (PLT) (×103/µL) with 78.66 (SD), 108.01 (DwWS), 153.47 (DwoWS) and 108.29 (non-SD); and aspartate aminotransferase (AST) (/µL) with 248.88 (SD), 170.83 (DwWS), 83.24 (DwoWS) and 102.99 (non-SD). For adult, WBC were 4.96 (SD), 6.44 (DwWS), 7.74 (DwoWS) and 3.61 (non-SD); HCT were 39.50 (SD), 39.00 (DwWS), 37.45 (DwoWS) and 41.68 (non-SD); PLT were 49.62 (SD), 96.60 (DwWS), 114.37 (DwoWS) and 71.13 (non-SD); and AST were 399.50 (SD), 141.01 (DwWS), 96.19 (DwoWS) and 118.13 (non-SD). These blood parameters could not differentiate between each dengue severity according to the WHO 2009 classification, SD, DwoWS, DwWS and non-SD, because the timing of blood drawing was not known and there was an overlapping confidence interval among the clinical classification. Hence, these pooled blood parameter values could not be used to guide clinicians in management and did not correlate with severity as in previous scientific literatures and guidelines.
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Affiliation(s)
- Gary KK Low
- Research Operations, Nepean Hospital, Kingswood, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sam Froze Jiee
- Sarawak State Health Department, Ministry of Health Malaysia, Sri Aman District Health Office, Sri Aman, Sarawak, Malaysia
| | - Retneswari Masilamani
- Department of Population Medicine, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
| | - Selvanaayagam Shanmuganathan
- Quality Unit, Hospital Kulim, Kulim, Kedah, Malaysia
- Menzies Centre Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Health Vertical, Torrens University Australia, Sydney, New South Wales, Australia
| | - Pramila Rai
- Health Vertical, Torrens University Australia, Sydney, New South Wales, Australia
| | - Mitali Manda
- Hammondcare Neringah Hospital, Wahroonga,New South Wales, Australia
| | - Osamudiamen Favour Omosumwen
- Department of Addiction and Community Health Professional, Faculty of Health and Social Science, Sundance College Edmonton, Edmonton, Alberta, Canada
| | - Jackob Kagize
- Health Vertical, Torrens University Australia, Sydney, New South Wales, Australia
| | - Alex I. Gavino
- Centre for Health Futures, Torrens University Australia, Sydney, New South Wales, Australia
- Public Health Department, Torrens University Australia, Sydney, New South Wales, Australia
| | - Aizad Azahar
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Mohammed Abdulrazzaq Jabbar
- Department of Population Medicine, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
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Wang C, Hong W, Ou Z, Yang H, Zhao L, Zhang Z, Zhang F. Prevalence, Characteristics, and Outcomes Associated with Acute Kidney Injury among Adult Patients with Severe Dengue in Mainland China. Am J Trop Med Hyg 2023; 109:404-412. [PMID: 37364862 PMCID: PMC10397446 DOI: 10.4269/ajtmh.22-0803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/01/2023] [Indexed: 06/28/2023] Open
Abstract
Acute kidney injury (AKI) can occur in adult patients with severe dengue (SD) and have serious clinical outcomes. This study aimed to determine the prevalence, characteristics, risk factors, and clinical outcomes of AKI in adult patients with SD; the correlation of dengue virus (DENV) serological and virological profiles with AKI; and the clinical features of patients with severe AKI who received renal replacement treatment (RRT). This multicenter study was conducted in Guangdong Province, China, between January 2013 and November 2019. A total of 242 patients were evaluated, of which 85 (35.1%) developed AKI and 32 (13.2%) developed severe AKI (stage 3). Patients with AKI had a higher fatality rate (22.4% versus 5.7%; P < 0.001) and longer length of hospital stay (median: 13 versus 9 days; P < 0.001). Independent risk factors for AKI were hypertension (odds ratio [OR]: 2.03; 95% CI: 1.10-3.76), use of nephrotoxic drugs (OR: 1.90; 95% CI: 1.00-3.60), respiratory distress (OR: 4.15; 95% CI: 1.787-9.632), high international normalized ratio (INR) levels (OR: 6.44; 95% CI: 1.89-21.95), and hematuria (OR: 2.12; 95% CI: 1.14-3.95). There was no significant association between DENV serological and virological profiles and the presence or absence of AKI. Among patients with severe AKI, those who received RRT had a longer length of hospital stay and similar fatality rate. Hence, adult patients with SD should be closely monitored for the development of AKI to enable timely and appropriate therapy.
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Affiliation(s)
- Changtai Wang
- Department of Infectious Disease, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Wenxin Hong
- Department of Infectious Disease, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Zhiyue Ou
- Department of Infectious Disease, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Huiqin Yang
- Department of Infectious Disease, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lingzhai Zhao
- Department of Clinical Laboratory, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zhenhua Zhang
- Department of Infectious Diseases, The Second Hospital of Anhui Medical University, Hefei, China
| | - Fuchun Zhang
- Department of Infectious Disease, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
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Bhattacharjee S, Ghosh D, Saha R, Sarkar R, Kumar S, Khokhar M, Pandey RK. Mechanism of Immune Evasion in Mosquito-Borne Diseases. Pathogens 2023; 12:pathogens12050635. [PMID: 37242305 DOI: 10.3390/pathogens12050635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
In recent decades, mosquito-borne illnesses have emerged as a major health burden in many tropical regions. These diseases, such as malaria, dengue fever, chikungunya, yellow fever, Zika virus infection, Rift Valley fever, Japanese encephalitis, and West Nile virus infection, are transmitted through the bite of infected mosquitoes. These pathogens have been shown to interfere with the host's immune system through adaptive and innate immune mechanisms, as well as the human circulatory system. Crucial immune checkpoints such as antigen presentation, T cell activation, differentiation, and proinflammatory response play a vital role in the host cell's response to pathogenic infection. Furthermore, these immune evasions have the potential to stimulate the human immune system, resulting in other associated non-communicable diseases. This review aims to advance our understanding of mosquito-borne diseases and the immune evasion mechanisms by associated pathogens. Moreover, it highlights the adverse outcomes of mosquito-borne disease.
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Affiliation(s)
| | - Debanjan Ghosh
- Department of Biotechnology, Pondicherry University, Puducherry 605014, India
| | - Rounak Saha
- Department of Biochemistry and Molecular Biology, Pondicherry University, Puducherry 605014, India
| | - Rima Sarkar
- DBT Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram 695014, India
| | - Saurav Kumar
- DBT Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram 695014, India
| | - Manoj Khokhar
- Department of Biochemistry, AIIMS, Jodhpur 342005, India
| | - Rajan Kumar Pandey
- Department of Medical Biochemistry and Biophysics, Karolinska Institute, 171 77 Solna, Sweden
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Mahmood A, Haq AU, Amin S, Rahim F, Noor M, Gul H, Zafar S, Ahmed Qureshi S, Batul K, Haq M. Predictors of Mortality in Patients With Dengue Fever: Insights From a Comparative Analysis. Cureus 2023; 15:e36040. [PMID: 37056528 PMCID: PMC10088565 DOI: 10.7759/cureus.36040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/13/2023] Open
Abstract
Objective To determine the clinical and biochemical predictors of mortality in patients with dengue fever. Methods This was an analytical, cross-sectional study conducted at Hayatabad Medical Complex, Peshawar, Pakistan. The study participants were patients admitted to the hospital for the management of dengue fever. Clinical parameters (age, gender, duration of hospital stay, and the presence of complications) and biochemical parameters [white blood cells count (WBC), platelet count, serum c-reactive protein (CRP) level, serum alanine aminotransferase (ALT) level, and serum creatinine] were recorded. These parameters were compared between the survivors and non-survivors of dengue fever. Results Out of 115 patients, the majority (n=82, 71.3%) were up to 45 years and the mean age was 38.40 ± 18.1 years. Most of the patients (n=105, 91.3%) survived. On univariate logistic regression analysis, age more than 45 years [odds ratio (OR) 0.141, 95% confidence interval (CI) 0.034 - 0.585, p = 0.007), leukocytosis (> 11,000/mcL) (OR 0.187, 95% CI 0.049 - 0.719, p = 0.015), and acute kidney injury (creatinine > 1.5 mg/dL) (OR 0.124, 95% CI 0.029 - 0.531, p = 0.005)] at the time of admission reduced the likelihood to survive. Leukocytosis and acute kidney injury remained significant independent predictors of mortality on multivariate logistic regression analysis. [(OR 0.201, 95% CI 0.042 - 0.960, p = 0.044) and (OR 0.148, 95% CI 0.026 - 0.857, p = 0.033) for survival, respectively]. Gender, duration of inpatient stay, thrombocytopenia (platelets < 30,000/mcL), and acute liver injury (ALT > 200 IU/L) were not associated with mortality from dengue fever. Conclusion Age over 45 years, leukocytosis, and acute kidney injury at presentation increased the likelihood of mortality from dengue fever in this study. Gender, duration of hospital stay, thrombocytopenia, and acute liver injury did not affect the odds of mortality.
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McBride A, Vuong NL, Van Hao N, Huy NQ, Chanh HQ, Chau NTX, Nguyet NM, Ming DK, Ngoc NT, Nhat PTH, Phong NT, Tai LTH, Tho PV, Trung DT, Tam DTH, Trieu HT, Geskus RB, Llewelyn MJ, Thwaites CL, Yacoub S. A modified Sequential Organ Failure Assessment score for dengue: development, evaluation and proposal for use in clinical trials. BMC Infect Dis 2022; 22:722. [PMID: 36057771 PMCID: PMC9441074 DOI: 10.1186/s12879-022-07705-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/23/2022] [Indexed: 11/19/2022] Open
Abstract
Background Dengue is a neglected tropical disease, for which no therapeutic agents have shown clinical efficacy to date. Clinical trials have used strikingly variable clinical endpoints, which hampers reproducibility and comparability of findings. We investigated a delta modified Sequential Organ Failure Assessment (delta mSOFA) score as a uniform composite clinical endpoint for use in clinical trials investigating therapeutics for moderate and severe dengue. Methods We developed a modified SOFA score for dengue, measured and evaluated its performance at baseline and 48 h after enrolment in a prospective observational cohort of 124 adults admitted to a tertiary referral hospital in Vietnam with dengue shock. The modified SOFA score included pulse pressure in the cardiovascular component. Binary logistic regression, cox proportional hazard and linear regression models were used to estimate association between mSOFA, delta mSOFA and clinical outcomes. Results The analysis included 124 adults with dengue shock. 29 (23.4%) patients required ICU admission for organ support or due to persistent haemodynamic instability: 9/124 (7.3%) required mechanical ventilation, 8/124 (6.5%) required vasopressors, 6/124 (4.8%) required haemofiltration and 5/124 (4.0%) patients died. In univariate analyses, higher baseline and delta (48 h) mSOFA score for dengue were associated with admission to ICU, requirement for organ support and mortality, duration of ICU and hospital admission and IV fluid use. Conclusions The baseline and delta mSOFA scores for dengue performed well to discriminate patients with dengue shock by clinical outcomes, including duration of ICU and hospital admission, requirement for organ support and death. We plan to use delta mSOFA as the primary endpoint in an upcoming host-directed therapeutic trial and investigate the performance of this score in other phenotypes of severe dengue in adults and children. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07705-8.
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Affiliation(s)
- Angela McBride
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Nguyen Lam Vuong
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Van Hao
- Hospital for Tropical Disease, Ho Chi Minh City, Vietnam
| | - Nguyen Quang Huy
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Ho Quang Chanh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Damien K Ming
- Department of Infectious Disease, Imperial College London, London, UK
| | | | | | | | | | - Phan Vinh Tho
- Hospital for Tropical Disease, Ho Chi Minh City, Vietnam
| | - Dinh The Trung
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Ronald Bertus Geskus
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Martin J Llewelyn
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - C Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Sophie Yacoub
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam. .,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
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Kaur G, Kumar V, Puri S, Tyagi R, Singh A, Kaur H. Look Out for Fever: Clinical Profile of Dengue in Young Adults in a Tertiary Care Center in North India. J Lab Physicians 2022; 15:78-83. [PMID: 37064990 PMCID: PMC10104709 DOI: 10.1055/s-0042-1751320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Abstract
Background Dengue fever (DF) is a common viral disease, clinical manifestations of which vary from influenza-like illness (DF) to life-threatening dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS). The aim of this article was to study the clinical profile of DF in young adults.
Material and Methods This was an observational study conducted in the department of medicine over a period of 2 years (January 1, 2013—December 31, 2014). Patients aged between 18 and 30 years with serology proven (nonstructural protein 1 [NS1]/dengue immunoglobulin M [IgM]) DF were included in this study. The clinical and laboratory data was recorded and analyzed.
Results Out of 418 cases, the incidence of DF, DHF, and DSS was 87.32, 7.66, and 5.02%, respectively. The most common presentations were fever (99.76%) followed by vomiting (29.43%), pain abdomen (17.94%), myalgias (13.16%), petechial rash (12.92%), and bleeding (10.29%). Dengue NS1 and IgM antibodies were positive in 87.3% and 88.12% of the patients, respectively. Ascites, splenomegaly, hepatomegaly, pleural effusion, gall bladder wall edema, and pericardial effusion were present in 8.13, 6.94, 6.70, 5.98, 2.63, and 0.72% of the patients, respectively. Complications included bleeding (10.29%), acute respiratory distress syndrome (1.67%), myocarditis (1.44%), seizures (1.44%), hemarthrosis (0.24%), and encephalopathy (0.24%). The mortality rate was 3.35% with death of 14 patients. Shock, bleeding, and elevated serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase levels predicted adverse outcome.
Conclusion DF can present with a plethora of clinical manifestations in endemic areas. Adverse outcome is more likely if patients have elevated SGOT levels, shock, and bleeding. Continuous seroepidemiological surveillance is essential to control outbreak and minimize morbidity and mortality.
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Affiliation(s)
- Gursheen Kaur
- Department of Cardiology, Oswal Cancer Hospital, Ludhiana, Punjab, India
| | - Vipin Kumar
- Department of General Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sandeep Puri
- Department of General Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ruchita Tyagi
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ashwajit Singh
- Department of Skin, JSS Medical College, Mysore, Karnataka, India
| | - Harpreet Kaur
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Gupta M, Agrawal N, Sharma SK, Ansari AK, Mahmood T, Singh L. Study of Utility of Basic Arterial Blood Gas Parameters and Lactate as Prognostic Markers in Patients With Severe Dengue. Cureus 2022; 14:e24682. [PMID: 35663676 PMCID: PMC9163704 DOI: 10.7759/cureus.24682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 01/15/2023] Open
Abstract
Background The importance of prognostication in critical care cannot be over-emphasized, especially in the context of diseases like dengue, as their presentation may vary from mild fever to critical life-threatening illness. With the help of prognostic markers, it is possible to identify patients at higher risk and thus improve their outcome with timely intervention. Basic arterial blood gas (ABG) parameters, i.e., potential of hydrogen (pH), partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2) and bicarbonate are useful parameters, especially in critical care medicine as they are known to vary with the severity of illness. Hyperlactatemia is often referred to as a “powerful predictor of mortality”. Basic ABG parameters and lactate have been used as an essential prognostic modality in critically ill patients for decades; however, the evidence remains limited for their role as prognostic markers in patients with severe dengue. Method We carried out an observational retrospective cohort study comprising 163 patients with severe dengue, admitted between July 2021 and November 2021 at Medical Intensive Care Unit (MICU) of Shri Ram Murti Smarak Institute of Medical Sciences (SRMS IMS), Bareilly, Uttar Pradesh, India. Basic ABG parameters and lactate levels at the time of admission to MICU were compared between survivor and non-survivor groups of patients with severe dengue in order to evaluate their prognostic utility as predictors of mortality. Results pH (p<0.0001), PO2 (p=0.01) and bicarbonate (<0.0001) levels were significantly lower, while PCO2 (p=0.002) and lactate (p<0.0001) levels were significantly higher in non-survivor group as compared to survivor group. Lactate was found to be the best prognostic marker with Area Under the Curve (AUC) of 88.7% on Receiver Operating Characteristics (ROC) analysis. Conclusion Basic arterial blood gas parameters and lactate can be used as feasible prognostic markers in patients with severe dengue.
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10
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Rescue therapy with intravenous immunoglobulin in severe refractory dengue: A pilot study. Med J Armed Forces India 2022; 78:204-212. [PMID: 35463535 PMCID: PMC9023533 DOI: 10.1016/j.mjafi.2020.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 12/31/2020] [Indexed: 11/23/2022] Open
Abstract
Background Severe dengue causes more than 22,000 deaths annually worldwide. Complicated dengue has high mortality of 44-72%. Disordered immune system with capillary leak and thrombocytopenia are hallmark of complicated dengue. Intravenous immunoglobulin (IV Ig) therapy has shown to be effective in complicated dengue in pediatric age group with refractory shock, but studies in adults are lacking. Its immunoresuscitative role is not yet fully explored in critically ill patients with severe dengue. Methods This is retrospective observational study of patients with complicated dengue fever who were administered IV Ig therapy in a tertiary care hospital of southern India from 01 Jan 2018 to 31 Dec 2019. Results A total of 999 patients with dengue were admitted; 754 (75.47%) were males, and 245 (24.53%) were females. A total of 402 (40.24%) patients presented with warning signs. Bleeding was seen in 121 patients (12.11%); 102 (10.21%) had shock; 29 (2.90%) had acute kidney injury and 24 (2.40%) had adult respiratory distress syndrome. Overall, four people died (mortality rate: 0.40%). IV Ig in the dose of 0.4 g/kg for 5 days was used in 13 critically ill patients where standard therapy failed, 9 patients with refractory shock (which included three with myocarditis with refractory shock), 2 with encephalitis, 2 in hemophagocytic lymphohistiocytosis. Two patients died, one with myocarditis with refractory shock and another with refractory shock. Conclusion IV Ig therapy in critically ill patients with complicated dengue can be used as a rescue therapy.
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11
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Turuk J, Palo SK, Rath S, Subhadra S, Sabat J, Sahoo PK, Panda S, Pati S. Viral characteristics and clinical presentation in dengue co-infection- Findings from a facility based observational study in Odisha, India. J Family Med Prim Care 2021; 10:2958-2963. [PMID: 34660431 PMCID: PMC8483126 DOI: 10.4103/jfmpc.jfmpc_2380_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/21/2021] [Accepted: 03/23/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Dengue has affected many countries globally. Two-fifths part of the world is at risk, which can be affected by dengue disease. In India, the dengue incidence has increased in the recent past and emerged as an important health problem in many states including Odisha. Dengue disease presents with atypical clinical symptoms when associated with other co-infections. Materials and Methods: A facility-based longitudinal study was carried out over a period of 1 year to determine the dengue co-infection and its outcome. The suspected cases were clinically assessed following a standard case report format and serological investigations including serotyping were carried out. Results: 33.6% samples were dengue positive of which 78.5% were positive for NS1 Ag, 26.6% positive for dengue IgM and 5.1% to both. Among the dengue positive cases, 60.9% were male and mean age was 31.52 (±17.03) years. High occurrence of cases was during May to November with maximum in August. Among the 975 dengue positives, 57 (5.8%) were found to have co-infection. Chikungunya was the most common co-infection in 71.9%, followed by herpes simplex (HSV) (7%) and other diseases. Fever was the most common presenting symptom (98.2%), followed by myalgia (91.2%), retro orbital pain (91.2%), pain abdomen (12.3%), rash/lesion (8.8%), burning micturition (5.3%), petechiae (1.7%) and pruritus (1.7%) among the co-infected cases. Conclusions: All the four dengue serotypes were found to be circulating with DEN 2 as the most predominant one. About 5.8% of dengue cases have co-infection (mainly with Chikungunya) and clinically present with atypical signs and symptoms.
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Affiliation(s)
| | - Subrata K Palo
- Department of Public Health, ICMR-RMRC Bhubaneswar, Odisha, India
| | - Sonalika Rath
- VRDL, ICMR-RMRC Bhubaneswar, Nalco Square, Odisha, India
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12
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Diptyanusa A, Phumratanaprapin W. Predictors and Outcomes of Dengue-Associated Acute Kidney Injury. Am J Trop Med Hyg 2021; 105:24-30. [PMID: 33939642 PMCID: PMC8274771 DOI: 10.4269/ajtmh.21-0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/18/2021] [Indexed: 12/16/2022] Open
Abstract
Dengue viral infections present with a wide clinical spectrum ranging from asymptomatic to severe manifestations with organ involvement. The term "expanded dengue syndrome" has been commonly used to illustrate the unusual or atypical manifestations; acute kidney injury (AKI) is one of the atypical manifestations of this syndrome. The use of heterogeneous criteria to determine the presence of AKI in dengue patients due to the vast diversity in populations led to difficulties in assessing the true incidence of dengue-associated AKI. This review presents a variable, but often high, frequency of dengue-associated AKI among vastly diverse populations with various disease severities. Dengue-associated AKI is not an uncommon complication, and its importance has often been neglected during the management of dengue patients. The risk factors and certain clinical and laboratory findings commonly reported among dengue patients with AKI should be considered to support a timely diagnosis and case management. This review highlights the need for clinicians to be aware of dengue-associated AKI to reduce the morbidity and mortality associated with this common and important tropical disease.
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Affiliation(s)
- Ajib Diptyanusa
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Weerapong Phumratanaprapin
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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13
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Byrne AB, García AG, Brahamian JM, Mauri A, Ferretti A, Polack FP, Talarico LB. A murine model of dengue virus infection in suckling C57BL/6 and BALB/c mice. Animal Model Exp Med 2021; 4:16-26. [PMID: 33738433 PMCID: PMC7954830 DOI: 10.1002/ame2.12145] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/01/2020] [Indexed: 12/20/2022] Open
Abstract
Dengue is a significant public health concern across tropical and subtropical regions worldwide, principally causing disease in children. Very young children are at increased risk of severe manifestations of dengue infection. The mechanism of dengue disease in this population is not fully understood. In this study, we present a murine model of dengue virus primary infection in suckling C57BL/6 and BALB/c mice in order to investigate disease pathogenesis. Three-day-old C57BL/6 mice intraperitoneally infected with DENV-2 NGC were more susceptible to infection than BALB/c mice, showing increased liver enzymes, extended viremia, dissemination to organs and histological alterations in liver and small intestine. Furthermore, the immune response in DENV-infected C57BL/6 mice exhibited a marked Th1 bias compared to BALB/c mice. These findings highlight the possibility of establishing an immunocompetent mouse model of DENV-2 infection in suckling mice that reproduces certain signs of disease observed in humans and that could be used to further study age-related mechanisms of dengue pathogenesis.
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Affiliation(s)
- Alana B. Byrne
- Fundación INFANTBuenos AiresArgentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)Buenos AiresArgentina
- Present address:
Laboratorio de Investigaciones Infectológicas y Biología MolecularInfectologíaDepartamento de MedicinaHospital de Niños Ricardo GutiérrezBuenos AiresArgentina
| | - Ayelén G. García
- Fundación INFANTBuenos AiresArgentina
- Present address:
Instituto Nacional de Enfermedades Infecciosas (INEI) ‐ Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) “Dr Carlos Malbrán”Buenos AiresArgentina
| | - Jorge M. Brahamian
- Fundación INFANTBuenos AiresArgentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)Buenos AiresArgentina
- Present address:
Departamento de Química Biológica‐IQUIBICEN (CONICET‐UBA)Facultad de Ciencias Exactas y NaturalesUniversidad de Buenos AiresBuenos AiresArgentina
| | | | | | | | - Laura B. Talarico
- Fundación INFANTBuenos AiresArgentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)Buenos AiresArgentina
- Present address:
Laboratorio de Investigaciones Infectológicas y Biología MolecularInfectologíaDepartamento de MedicinaHospital de Niños Ricardo GutiérrezBuenos AiresArgentina
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14
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Brar R, Sikka P, Suri V, Singh MP, Suri V, Mohindra R, Biswal M. Maternal and fetal outcomes of dengue fever in pregnancy: a large prospective and descriptive observational study. Arch Gynecol Obstet 2021; 304:91-100. [PMID: 33389093 PMCID: PMC7778400 DOI: 10.1007/s00404-020-05930-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/27/2020] [Indexed: 11/25/2022]
Abstract
Purpose The primary objective of the study was to assess maternal and fetal outcomes of pregnancies affected with dengue fever. Methods This was a prospective, observational and descriptive study carried out over a period of 1 year. 216 pregnant women with fever were screened. Of these, 44 women tested positive for dengue (non-structural protein antigen 1 or dengue IgM antibodies in the sera). The clinical and laboratory characteristics of women with dengue were recorded. Maternal outcomes, pregnancy outcomes and fetal outcomes were studied. Results Mean period of gestation was 31.89 ± 7.31 weeks. Thrombocytopenia was seen in 23 (52.3%) women. Of 40 women, 10 (25%) developed post-partum haemorrhage. The incidence of maternal systemic complications was high: eight (18.2%) women developed acute kidney injury and two (4.5%) required haemodialysis support; eight (18.2%) women developed ARDS and seven (15.9%) women required ventilatory support; four (9.1%) women developed acute liver failure. 18 (40.9%) women had evidence of shock. Seven (15.9%) women died and another seven (15.9%) were classified as WHO maternal near-miss cases. Two (4.5%) pregnancies suffered from miscarriages, four (9%) from still births and two (4.5%) from neonatal deaths. Preterm babies were delivered in 15 (34.1%) and low birth weight babies in 13 (29.5%). Conclusions Dengue in pregnancy adversely affects maternal and fetal outcomes with high maternal mortality of 15.9%. Prematurity and postpartum haemorrhage are significant risks to mother and baby. Vector control strategies should be implemented with vigour in affected areas.
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Affiliation(s)
- Rinnie Brar
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Pooja Sikka
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
| | - Vikas Suri
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Mini P Singh
- Department of Virology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Ritin Mohindra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Manisha Biswal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
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Channapatna Suresh S, Hanumanthaiha R, Ramakrishna C, Sandeep R, Narasimhasetty PS, Ramakrihna V, P BK, Raju B. Serum Ferritin As a Prognostic Indicator in Adult Dengue Patients. Am J Trop Med Hyg 2020; 104:1072-1078. [PMID: 33372649 DOI: 10.4269/ajtmh.20-1111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/08/2020] [Indexed: 01/04/2023] Open
Abstract
Dengue virus (DENV) infection is increasing with rapid urbanization in India. Treatment of DENV infection is mainly supportive with no specific antiviral therapy. Although most patients show mild illness, some have a severe disease course such as dengue hemorrhagic syndrome, dengue shock, multi-organ failure, and death. The cause for severity is not fully understood. Currently, there are no methods available to predict the course of the illness. Hence, it is crucial to develop an early biomarker to predict the course of dengue illness which can aid in vigorous monitoring and early intervention. Here, we tried to establish a correlation between serum ferritin and severity of dengue illness. We measured ferritin levels in 100 dengue-positive cases on day 1 (D1) (febrile phase) and day 4 (D4) (defervescence or convalescent) of admissions to compare the levels with the severity of the disease. On D1, the serum ferritin level was a "good" predictor of severe dengue, with an area under the curve (AUC) of 0.863 with standard error (SE) = 0.043 and a 95% CI from 0.778 to 0.947 (P < 0.05). On D4, serum ferritin was an "excellent" predictor of severe dengue, with an AUC of 0.947 with SE = 0.021 and a 95% CI from 0.907 to 0.988 (P < 0.05). Serum ferritin is an inexpensive and easily accessible biomarker that can assist in monitoring and prognosticating the dengue-positive patients. This biomarker also directs us to explore the underlying pathogenetic mechanism in severe dengue, which can lay a foundation for future targeted therapeutic options to combat severe illness.
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Affiliation(s)
- Sumatha Channapatna Suresh
- Department of Medicine, Kempegowda Institute of Medical Science and Research Institute, Bengaluru, India
| | - Rajeev Hanumanthaiha
- Department of Medicine, Kempegowda Institute of Medical Science and Research Institute, Bengaluru, India
| | - Chethana Ramakrishna
- Department of Medicine, Kempegowda Institute of Medical Science and Research Institute, Bengaluru, India
| | - Ramishetty Sandeep
- Department of Medicine, Kempegowda Institute of Medical Science and Research Institute, Bengaluru, India
| | | | - Vedavathy Ramakrihna
- Department of Medicine, Kempegowda Institute of Medical Science and Research Institute, Bengaluru, India
| | - Balraj K P
- Department of Medicine, Kempegowda Institute of Medical Science and Research Institute, Bengaluru, India
| | - Bharath Raju
- Department of Neurosurgery, Kempegowda Institute of Medical Science and Research Institute, Bengaluru, India
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Abstract
Scrub typhus is a mite-borne rickettsial infection that presents with fever and a diverse array of complications. Lately, many epidemics have been reported from the Indian subcontinent. Data from these outbreaks suggest that liver injury in scrub typhus is common and reversible. We are reporting the case of a 27-year-old pregnant female who presented with fever, encephalopathy, jaundice and seizure. She had acute liver failure and dead fetus on admission. Despite appropriate antibiotics and supportive treatment, she continued to deteriorate and developed multiorgan dysfunction, leading to her demise.
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Affiliation(s)
- Saurabh Gaba
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Sanjana Sharma
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Nayana Gaba
- Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND.,Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, IND
| | - Monica Gupta
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
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17
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Shastri PS, Gupta P, Kumar R. A prospective 3 year study of clinical spectrum and outcome of dengue fever in ICU from a tertiary care hospital in North India. Indian J Anaesth 2020; 64:181-186. [PMID: 32346163 PMCID: PMC7179772 DOI: 10.4103/ija.ija_865_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/25/2020] [Accepted: 02/12/2020] [Indexed: 01/09/2023] Open
Abstract
Background and Aims: The incidence of specific complications and adverse outcomes in dengue patients needing admission to intensive care units (ICU) may be quite variable in different regions of India presumably because of different strains of dengue virus or due to re infection. Methods: Patients admitted with acute febrile illness (AFI) with either positive IgM antibody or NS1 antigen for dengue were enrolled. Data were collected for 3 years (2015-2017). A total of 313 patients with acute febrile illness were admitted in the study period (2252 total ICU admissions). A total of 137 (43.76%) cases were serologically proven as dengue fever. Results: Median age (IQR) of study population was 36.0 (26.0–52.0) years. Liver (65.7%) was the main organ involved followed by acute kidney Injury (AKI) (18.6%). Dengue Shock Syndrome (DSS) was found in 18.6% of cases. Fifty-two patients died and the crude mortality was 38.0%. On multivariate analysis APACHE Score <10, thrombocytopenia, hepatic dysfunction, AKI and dengue shock syndrome (DSS) were associated with the risk of mortality. Conclusion: This study in ICU patients showed high mortality in relatively younger patients. Liver (in the form of raised Bilirubin) was the most common organ dysfunction. The need to recognise early warning signs for ICU admission is highlighted.
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Affiliation(s)
- Prakash S Shastri
- Department of Critical Care and Emergency Medicine, Sir Gangaram Hospital, New Delhi, India
| | - Prasoon Gupta
- Department of Critical Care and Emergency Medicine, Sir Gangaram Hospital, New Delhi, India
| | - Rahul Kumar
- Department of Critical Care and Emergency Medicine, Sir Gangaram Hospital, New Delhi, India
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