Please use this identifier to cite or link to this item: https://doi.org/10.1186/s12879-014-0649-2
Title: Early clinical and laboratory risk factors of intensive care unit requirement during 2004-2008 dengue epidemics in Singapore: A matched case-control study
Authors: Pang, J 
Thein, T.-L
Leo, Y.-S 
Lye, D.C 
Keywords: alanine aminotransferase
urea
adolescent
adult
age
aged
alanine aminotransferase blood level
Article
blood pressure
case control study
comorbidity
controlled study
dengue
diabetes mellitus
disease severity
epidemic
female
fever
hematocrit
human
hypoproteinemia
hypotension
intensive care
length of stay
lymphocyte count
major clinical study
male
middle aged
monocyte
mortality
predictive value
prognosis
pulse rate
retrospective study
sensitivity and specificity
Singapore
thrombocyte count
urea blood level
young adult
decision support system
dengue
epidemic
evaluation study
intensive care
intensive care unit
multivariate analysis
risk factor
statistical analysis
statistical model
statistics and numerical data
utilization
very elderly
Adolescent
Adult
Aged
Aged, 80 and over
Critical Care
Decision Support Techniques
Dengue
Epidemics
Female
Humans
Intensive Care Units
Logistic Models
Male
Matched-Pair Analysis
Middle Aged
Multivariate Analysis
Prognosis
Retrospective Studies
Risk Factors
Sensitivity and Specificity
Singapore
Young Adult
Issue Date: 2014
Citation: Pang, J, Thein, T.-L, Leo, Y.-S, Lye, D.C (2014). Early clinical and laboratory risk factors of intensive care unit requirement during 2004-2008 dengue epidemics in Singapore: A matched case-control study. BMC Infectious Diseases 14 (1) : 649. ScholarBank@NUS Repository. https://doi.org/10.1186/s12879-014-0649-2
Rights: Attribution 4.0 International
Abstract: Background: Dengue infection can result in severe clinical manifestations requiring intensive care. Effective triage is critical for early clinical management to reduce morbidity and mortality. However, there is limited knowledge on early risk factors of intensive care unit (ICU) requirement. This study aims to identify early clinical and laboratory risk factors of ICU requirement at first presentation in hospital and 24 hours prior to ICU requirement. Method: A retrospective 1:4 matched case-control study was performed with 27 dengue patients who required ICU, and 108 dengue patients who did not require ICU from year 2004-2008, matched by year of dengue presentation. Univariate and multivariate conditional logistic regression were performed. Optimal predictive models were generated with statistically significant risk factors identified using stepwise forward and backward elimination method. Results: ICU dengue patients were significantly older (P=0.003) and had diabetes (P=0.031), compared with non-ICU dengue patients. There were seven deaths among ICU patients at median seven days post fever. At first presentation, the WHO 2009 classification of dengue severity was significantly associated (P<0.001) with ICU, but not the WHO 1997 classification. Early clinical risk factors at presentation associated with ICU requirement were hematocrit change ?20% concurrent with platelet <50 K [95% confidence-interval (CI)=2.46-30.53], hypoproteinemia (95% CI=1.09-19.74), hypotension (95% CI=1.83-31.79) and severe organ involvement (95% CI=3.30-331). Early laboratory risk factors at presentation were neutrophil proportion (95% CI=1.04-1.17), serum urea (95% CI=1.02-1.56) and alanine aminotransferase level (95% CI=1.001-1.06). This predictive model has sensitivity and specificity up to 88%. Early laboratory risk factors at 24 hours prior to ICU were lymphocyte (95% CI=1.03-1.38) and monocyte proportions (95% CI=1.02-1.78), pulse rate (95% CI=1.002-1.14) and blood pressure (95% CI=0.92-0.996). This predictive model has sensitivity and specificity up to 88.9% and 78%, respectively. Conclusions: This is the first matched case-control study, to our best knowledge, that identified early clinical and laboratory risk factors of ICU requirement during hospitalization. These factors suggested differential pathophysiological background of dengue patients as early as first presentation prior to ICU requirement, which may reflect the pathogenesis of dengue severity. These risk models may facilitate clinicians in triage of patients, after validating in larger independent studies. © 2014 Pang et al.
Source Title: BMC Infectious Diseases
URI: https://scholarbank.nus.edu.sg/handle/10635/181476
ISSN: 14712334
DOI: 10.1186/s12879-014-0649-2
Rights: Attribution 4.0 International
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