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Platelet counts predict dengue shock syndrome in children
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Daily monitoring of platelet counts in children with dengue fever could assist in recognizing those that are most at risk for developing dengue shock syndrome, according to data published in PLoS Neglected Tropical Diseases.
Researchers noted a need for prediction models that include signs, symptoms and daily lab measurements, which could improve predictions and reduce the burden experienced by health services.
“As of yet, no effective antiviral or immunomodulatory therapy [for dengue] has been identified, but with careful observation and judicious use of intravenous fluid therapy to counteract plasma leakage, most notably urgent volume resuscitation for patients with established [dengue shock syndrome], mortality rates have been reduced to less than 1% in specialist centers,” Phung Khanh Lam, MD, PhD, from the Oxford University Clinical Research Unity, Hospital for Tropical Diseases, in Vietnam, and colleagues wrote.
The researchers also note that mortality rates have occasionally been reported at up to 10%.
To assess risk factors for dengue shock syndrome (DSS) and to evaluate the value of incorporating serial hematocrit and platelet measurements in prediction models, the researchers examined data collected in a prospective observational study. Participants were Vietnamese children between the ages of 5 and 15 years who were hospitalized with clinically suspected dengue.
Children who were analyzed included all children treated between 2001 and 2009 at the Hospital for Tropical Diseases in Ho Chi Minh City. Enrollment of children with lab-confirmed dengue occurred between 1 and 4 days of illness. Daily levels of hematocrit and platelets were assessed on each day of illness.
Among 2,301 children with dengue infections, 6% developed DSS. Those who exhibited vomiting, higher temperature, a palpable liver and low platelet counts were at significant risk of developing the syndrome, and when models that included serial daily platelet counts were used as opposed to enrolment information only, patients at risk were identified with more ease.
Although the inclusion of daily platelet levels assisted in the identification of those who were most likely to develop DSS, the inclusion of hematocrit values did not.
“Although the concept of hospitalization based on warning signs has become established in recent years, the strong community perception of dengue as a dangerous disease in childhood, combined with major transport/logistic difficulties during the study years especially at night, resulted in a low threshold for hospitalization at that time,” Lam and colleagues wrote. “Early enrollment likely explains the lower incidence of DSS in our cohort compared to contemporaneous reports from Ho Chi Minh city that described all hospital cases.” — by Katherine Bortz
Disclosure: The researchers report no relevant financial disclosures.
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