Lam Phung Khanh, Ngoc Tran Van, Thu Thuy Truong Thi, Hong Van Nguyen Thi, Nhu Thuy Tran Thi, Hoai Tam Dong Thi, Dung Nguyen Minh, Hanh Tien Nguyen Thi, Thanh Kieu Nguyen Tan, Simmons Cameron, Wills Bridget, Wolbers Marcel
Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam.
Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam.
PLoS Negl Trop Dis. 2017 Apr 27;11(4):e0005498. doi: 10.1371/journal.pntd.0005498. eCollection 2017 Apr.
Dengue is the most important mosquito-borne viral infection to affect humans. Although it usually manifests as a self-limited febrile illness, complications may occur as the fever subsides. A systemic vascular leak syndrome that sometimes progresses to life-threatening hypovolaemic shock is the most serious complication seen in children, typically accompanied by haemoconcentration and thrombocytopenia. Robust evidence on risk factors, especially features present early in the illness course, for progression to dengue shock syndrome (DSS) is lacking. Moreover, the potential value of incorporating serial haematocrit and platelet measurements in prediction models has never been assessed.
METHODOLOGY/PRINCIPAL FINDINGS: We analyzed data from a prospective observational study of Vietnamese children aged 5-15 years admitted with clinically suspected dengue to the Hospital for Tropical Diseases in Ho Chi Minh City between 2001 and 2009. The analysis population comprised all children with laboratory-confirmed dengue enrolled between days 1-4 of illness. Logistic regression was the main statistical model for all univariate and multivariable analyses. The prognostic value of daily haematocrit levels and platelet counts were assessed using graphs and separate regression models fitted on each day of illness. Among the 2301 children included in the analysis, 143 (6%) progressed to DSS. Significant baseline risk factors for DSS included a history of vomiting, higher temperature, a palpable liver, and a lower platelet count. Prediction models that included serial daily platelet counts demonstrated better ability to discriminate patients who developed DSS from others, than models based on enrolment information only. However inclusion of daily haematocrit values did not improve prediction of DSS.
CONCLUSIONS/SIGNIFICANCE: Daily monitoring of platelet counts is important to help identify patients at high risk of DSS. Development of dynamic prediction models that incorporate signs, symptoms, and daily laboratory measurements, could improve DSS prediction and thereby reduce the burden on health services in endemic areas.
登革热是影响人类的最重要的蚊媒病毒感染。虽然它通常表现为自限性发热疾病，但发热消退时可能会出现并发症。系统性血管渗漏综合征有时会发展为危及生命的低血容量性休克，这是儿童中最严重的并发症，通常伴有血液浓缩和血小板减少。目前缺乏关于危险因素，尤其是疾病早期出现的特征，与发展为登革热休克综合征（DSS）之间关系的确凿证据。此外，在预测模型中纳入连续血细胞比容和血小板测量的潜在价值从未得到评估。
方法/主要发现：我们分析了2001年至2009年间在胡志明市热带病医院收治的临床疑似登革热的5至15岁越南儿童的前瞻性观察性研究数据。分析人群包括所有在发病第1至4天确诊为登革热的儿童。逻辑回归是所有单变量和多变量分析的主要统计模型。使用图表和在疾病的每一天拟合的单独回归模型评估每日血细胞比容水平和血小板计数的预后价值。在纳入分析的2301名儿童中，143名（6%）发展为DSS。DSS的显著基线危险因素包括呕吐史、体温较高、肝脏可触及和血小板计数较低。与仅基于入院信息的模型相比，纳入连续每日血小板计数的预测模型在区分发生DSS的患者和其他患者方面表现出更好的能力。然而，纳入每日血细胞比容值并未改善DSS的预测。
结论/意义：每日监测血小板计数对于帮助识别DSS高危患者很重要。开发结合体征、症状和每日实验室测量的动态预测模型，可以改善DSS预测，从而减轻流行地区卫生服务的负担。
