Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina de São José do Rio Preto, Av. Brg. Faria Lima, 5416 - Vila Sao Pedro, São José do Rio Preto - São Paulo, CEP 15090-000, Brazil.
Faculdade de Medicina, União das Faculdades dos Grandes Lagos, São José do Rio Preto, São Paulo, 15030-070, Brazil.
Trans R Soc Trop Med Hyg. 2020 Aug 1;114(8):603-611. doi: 10.1093/trstmh/traa031.
We evaluated the validity of clinical diagnosis compared with laboratory diagnosis of dengue in a retrospective sample of patients in São José do Rio Preto, Brazil.
Our sample included 148 299 clinically (56.3%) or laboratory-diagnosed (43.7%) dengue cases. We compared the sensitivity, specificity, positive and negative predictive value (PPV and NPV) of dengue patients' demographic and clinical characteristics with laboratory-based diagnosis. We used logistic regressions to estimate the correlation between clinical and laboratory diagnosis of dengue and a full set of dengue signs and symptoms.
We found substantial variability in sensitivity and specificity of signs and symptoms ranging from 0.8-81.1 and 21.5-99.6, respectively. Thrombocytopenia exhibited the highest PPV (92.0) and lowest NPV (42.2) and was the only symptom showing agreement with laboratory-confirmed dengue (φ = 0.38). The presence of exanthema and thrombocytopenia led to a greater likelihood of concordant clinical and laboratory diagnoses (exanthema: OR: 4.23; 95% CI: 2.09 to 8.57; thrombocytopenia: OR: 4.02; 95% CI: 1.32 to 12.27).
We found substantial variation in sensitivity, specificity, PPV and NPV of dengue signs and symptoms. For accuracy, clinical and laboratory diagnosis of dengue should be performed concurrently. When laboratory tests are not available, we suggest focusing on the clinical manifestations most associated with dengue.
我们评估了巴西圣若泽杜里奥普雷托回顾性样本中临床诊断与实验室诊断登革热的有效性。
我们的样本包括 148299 例临床（56.3%）或实验室诊断（43.7%）的登革热病例。我们比较了登革热患者的人口统计学和临床特征与基于实验室的诊断的敏感性、特异性、阳性和阴性预测值（PPV 和 NPV）。我们使用逻辑回归估计临床和实验室诊断登革热与全套登革热体征和症状之间的相关性。
我们发现体征和症状的敏感性和特异性存在很大差异，范围分别为 0.8-81.1 和 21.5-99.6。血小板减少症的 PPV 最高（92.0），NPV 最低（42.2），是唯一与实验室确诊登革热一致的症状（φ=0.38）。皮疹和血小板减少症的存在更有可能导致临床和实验室诊断一致（皮疹：OR：4.23；95%CI：2.09 至 8.57；血小板减少症：OR：4.02；95%CI：1.32 至 12.27）。
我们发现登革热体征和症状的敏感性、特异性、PPV 和 NPV 存在很大差异。为了准确性，应同时进行临床和实验室诊断登革热。当无法进行实验室检测时，我们建议重点关注与登革热最相关的临床表现。
