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Original Article

Predictors of Severity of Dengue Fever in Tertiary Care Hospitals

Nadia Shams, Sadia Amjad, Nadeem Yousaf, Waqar Ahmed, Naresh Kumar Seetlani, Nadia Qaisar, Samina.

BACKGROUND: Dengue fever, an emerging public health issue in Pakistan bears considerable
morbidity and mortality. This descriptive cross sectional study was conducted to analyze
clinical, hematological and serological characteristics of dengue fever variants and to identify
biomarkers that predict its severity.
METHODS: 105 dengue cases (>12 years) were selected after ethical approval from Rawal
Institute of Health Sciences & Benazir Bhutto Hospital Rawalpindi over 6 months (July to Dec
2015). Patients having pre-existing hematological disorder, liver disease, malaria and typhoid
co-infection were excluded. Demographic data, clinical findings, hematological and serological
profile documented. Patients were classified as classic dengue fever (DF), dengue hemorrhagic
(DHF) and dengue shock syndrome (DSS). Data analyzed via SPSS version 17.
RESULTS: Among 105 cases, there were 79(75%) males and 26(25%) females. Mean age was 30
+12.8 years and mean duration of symptoms 5 +2 days. Dengue fever was found in 75(75%),
dengue hemorrhagic fever 24(23%) and dengue shock syndrome 2(2%). Gender, mean age and
duration of symptoms were comparable between DF, DHF and DSS. Common clinical features
were fever (100%), headache (56%), muscle pain (43%), vomiting (43%), retro-orbital pain (23%),
bleeding (12%) and hypotension (10%). Thrombocytopenia, leukopenia and pancytopenia were
frequent in DHF vs. DF. Dengue NS-1 antigen positive in 71(90%) of DF cases vs 16(57%) DHF
and 1(50%) DSS. Dengue-IgM positive in 32(47%) DF vs. 19(79%) DHF and 2(100%) DSS. Dengue
-IgG detected in 33(42%) DF vs. 17(71%) DHF and 1(50%) DSS. 101(96%) dengue cases were
treated successfully and one case expired.
CONCLUSION: Dengue-IgG and IgM are better predictive variables for dengue hemorrhagic
fever as compared to NS-1 antigen that predicts classic dengue fever. Utilizing these predictive
variables, imminent severe dengue may be identified and with vigilant monitoring, fluid
resuscitation and pre-hand arrangement of blood products we may reduce complications and
mortality in high risk cases.

Key words: Dengue fever. Dengue hemorrhagic fever. Dengue shock syndrome.

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