APACHE, Dengue fever, SOFA, Severe Dengue, Transaminitis
Citation Information :
Padyana M, Karanth S, Vaidya S, Gopaldas JA. Clinical Profile and Outcome of Dengue Fever in Multidisciplinary Intensive Care Unit of a Tertiary Level Hospital in India. Indian J Crit Care Med 2019; 23 (6):270-273.
Background: India is one of the seven identified countries in South-East Asia region regularly reporting dengue fever (DF)/dengue hemorrhagic fever (DHF) outbreaks. Even though the dengue prodrome and evolution of illness are most often similar in many patients, progress and outcome may differ significantly depending on the severity of illness as well as treatment instituted. We studied the clinical manifestations, outcome and factors predicting mortality of serology confirmed dengue fever cases admitted in Multidisciplinary Intensive Care Unit (MICU) of a high acuity healthcare facility in India.
Methodology: All patients with serology proven dengue fever admitted to MICU between 1st July 2015 and1st December 2015 were included in the study. Clinical presentation, laboratory findings, severity of illness scores and outcome were recorded.
Results: Majority of the patients (58.4%) belonged to 21–40 year age group. Hepatic (96.8%) followed by hematological (79.2%) involvement were the most common findings. CNS involvement observed among 27%. Survival to hospital discharge was 78.9%. Respiratory and gastrointestinal system involvement was associated with increased mortality. Acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and shock were the clinical syndromes associated with mortality. Serum lactate, aspartate transaminase (AST) and alanine transaminase (ALT) were significantly elevated among non survivors. Significant difference in sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) scores was also observed among survivors and non survivors.
Conclusion: Organ system involvement and higher disease severity scores are strong predictors of mortality. High index of suspicion for atypical manifestations of dengue is warranted.
Laul A, Laul P, Merugumala V, Pathak R, Miglani U, Saxena P. Clinical Profiles of Dengue Infection during an Outbreak in Northern India. J Tropical Med. 2016; 1-7. http://dx.doi.org/10.1155/2016/5917934
Mutheneni SR, Morse AP, Caminade C, Upadhyayula SM. Dengue burden in India: recent trends and importance of climatic parameters. Emerg Microbes Infect. 2017; 6(8): e70. doi: 10.1038/emi.2017.57
Chen CM, Chan KS, Yu WL, Cheng KC, Chao HC, Yeh CYet al. The outcomes of patients with severe dengue admitted to intensive care units. Medicines 2016;95:31. doi: 10.1097/MD.0000000000004376
Juneja D, Nasa P, Singh O, Javeri Y, Uniyal B, Dang R: Clinical profile, intensive care unit course, and outcome of patients admitted in intensive care unit with dengue. J Crit Care 2011; 26(5):449–452. doi: 10.1016/j.jcrc.2011.05.007
Ong A, Sandar M, Chen MI, Sin LY. Fatal dengue hemorrhagic fever in adults during a dengue epidemic in Singapore. Int J Infec Dis 2007;11: 263-267. DOI: 10.1016/j.ijid.2006.02.012
Nayak J, Behera S, Swain SK, Panda SR.A study of multiorgan dysfunction in patients with dengue and its clinicohematological correlation with severity. Asian J Pharm Clin Res. 2017;10(2):218–221.
Thanachartwet V, Desakorn V, Sahassananda D, Jittmittraphap A, Areemitr NO, Osothsomboon S et al. Serum Procalcitonin and peripheral venous lactate for predicting Dengue Shock and/or organ failure: A prospective observational study. PlosNegl Trop Dis. 2016; 10(8): e 0004961. https://doi.org/10.1371/journal.pntd.0004961
Jain S, Mittal A, Sharma SK, Upadhyay AD, Pandey RM, Sinha S et al. Predictors of Dengue-Related Mortality and Disease Severity in a Tertiary Care Center in North India. Open Forum Infectious Diseases. 2017; 4 (2), 1-8. doi: 10.1093/ofid/ofx056.
Routray SS, Mohanty DP, Mishra D. Clinical profile, Intensive care Unit course and outcome of patients admitted in intensive care unit with dengue. Indian J Clin Anaesth. 2016; 3(1): 33-35
Madi D, Achappa B, Ramapuram JT, Chowta N, Laxman M, Mahalingam S. Dengue encephalitis- A rare manifestation of dengue fever. Asian Pac J Trop Biomed 2014; 4(suppl 1):S70- S72. doi: 10.12980/APJTB.4.2014C1006.
Karoli R, Fatima J, Siddiqi Z, Kazmi KI, Sultania AR. Clinical profile of dengue infection at a teaching hospital in North India. 2010; 2010–2013.
Nimmagadda SS, Mahabala C, Boloor A, Raghuram PM, Nayak AU. Atypical Manifestations of Dengue Fever (DF) – Where Do We Stand Today? J Clin Diag Res. 2014; 8(1): 71-73. doi: 10.7860/JCDR/2014/6885.3960
Yeh CY, Chen PL, Chuang KT, Shu, Chien YW, Perng GC et al. Symptoms associated with adverse dengue fever prognoses at the time of reporting in the 2015 dengue outbreak in Taiwan. PlosNegl Trop Dis. 2017; 11(12): e 0006091. doi: 10.1371/journal.pntd.0006091
Pinto RC, Castro DBd, Albuquerque BCd, SampaioVdS, PassosRAd, Costa CFd, et al. Mortality Predictors in Patients with Severe Dengue in the State of Amazonas, Brazil. PLoS. ONE. 2016;11(8): e0161884. https://doi.org/10.1371/journal.pone.0161884
Pang J, Thein TL, Leo YS, Lye DC. Early clinical and laboratory risk factors of intensive care unit requirement during 2004–2008 dengue epidemics in Singapore: a matched case–control study. BMC Infect Dis 2014; 14:649. doi: 10.1186/s12879-014-0649-2
Pang J, Salim A, Lee VJ, Hibberd ML, Chia KS, Leo YS, Lye DC: Diabetes with hypertension as risk factors for adult dengue hemorrhagic fever in a predominantly dengue serotype 2 epidemic: a case control study. PLoSNegl Trop Dis 2012; 6(5):e1641. doi: 10.1371/journal.pntd.0001641