Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pone.0148579
Title: Identifying adult dengue patients at low risk for clinically significant bleeding
Authors: Wong J.G.X.
Thein T.L.
Leo Y.-S. 
Pang J. 
Lye D.C. 
Keywords: abdominal pain
abdominal tenderness
adult
Article
bleeding
body temperature
cohort analysis
controlled study
demography
dengue
disease severity
female
gender
hematocrit
hospital admission
hospital patient
hospitalization
human
human cell
laboratory test
low risk patient
lymphocyte count
major clinical study
male
medical parameters
nausea
neutrophil count
prothrombin time
pulse rate
reference value
retrospective study
risk assessment
risk factor
sensitivity and specificity
Singapore
systolic blood pressure
thrombocyte count
vomiting
adolescent
complication
dengue
Hemorrhage
menorrhagia
middle aged
mortality
multivariate analysis
severe dengue
vomiting
young adult
Adolescent
Adult
Cohort Studies
Dengue
Female
Hemorrhage
Humans
Male
Menorrhagia
Middle Aged
Multivariate Analysis
Platelet Count
Retrospective Studies
Risk Factors
Severe Dengue
Vomiting
Young Adult
Issue Date: 2016
Citation: Wong J.G.X., Thein T.L., Leo Y.-S., Pang J., Lye D.C. (2016). Identifying adult dengue patients at low risk for clinically significant bleeding. PLoS ONE 11 (2) : e0148579. ScholarBank@NUS Repository. https://doi.org/10.1371/journal.pone.0148579
Rights: Attribution 4.0 International
Abstract: Background Clinically significant bleeding is important for subsequent optimal case management in dengue patients, but most studies have focused on dengue severity as an outcome. Our study objective was to identify differences in admission parameters between patients who developed clinically significant bleeding and those that did not. We sought to develop a model for discriminating between these patients. Methods We conducted a retrospective study of 4,383 adults aged >18 years who were hospitalized with dengue infection at Tan Tock Seng Hospital, Singapore from 2005 to 2008. Patients were divided into those with clinically significant bleeding (n = 188), and those without (n = 4,195). Demographic, clinical, and laboratory variables on admission were compared between groups to determine factors associated with clinically significant bleeding during hospitalization. Results On admission, female gender (p<0.001); temperature >38癈 (p<0.001); nausea/vomiting (p = 0.009) and abdominal pain/tenderness (p = 0.005); lower systolic blood pressure (p<0.001); higher pulse rate (p<0.001); increased absolute neutrophil count (ANC; p<0.001); reduced absolute lymphocyte count (ALC; p<0.001), haematocrit percentage (p<0.001) and platelet count (p = 0.04), and increased prothrombin time (p = 0.003) were significantly associated with clinically significant bleeding on univariate analysis. Multivariate analysis showed that independent variables in the final model were female gender (aOR 2.85; 95% CI: 1.9-4.33); temperature >38癈 (aOR 1.81; 95% CI: 1.27-2.61), nausea/ vomiting (aOR 1.39; 95% CI: 0.94-2.12), ANC (aOR 1.3; 95% CI: 1.15-1.46), ALC (aOR 0.4; 95% CI: 0.25-0.64), hematocrit percentage (aOR 0.96; 95% CI: 0.92-1.002) and platelet count (aOR 0.993; 95% CI: 0.988-0.998). At the cutoff of -3.919, the model achieved an AUC of 0.758 (sensitivity:0.87, specificity: 0.38, PPV: 0.06, NPV: 0.98). Conclusion Clinical risk factors associated with clinically significant bleeding were identified. This model may be useful to complement clinical judgement in triaging adult dengue patients given the dynamic nature of acute dengue, particularly in pre-identifying those less likely to develop clinically significant bleeding. � 2016 Wong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Source Title: PLoS ONE
URI: https://scholarbank.nus.edu.sg/handle/10635/161589
ISSN: 19326203
DOI: 10.1371/journal.pone.0148579
Rights: Attribution 4.0 International
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