Abstract
The aim of this study was to examine retrospective dengue-illness classification using only clinical laboratory data, without relying on X-ray, ultrasound, or percent hemoconcentration. We analyzed data from a study of children who presented with acute febrile illness to two hospitals in Thailand. Multivariable logistic regression models were used to distinguish: (1) dengue hemorrhagic fever (DHF) versus dengue fever (DF), (2) DHF versus DF + other febrile illness (OFI), (3) dengue versus OFI, and (4) severe dengue versus non-severe dengue + OFI. Data from the second hospital served as a validation set. There were 1,227 patients in the analysis. The sensitivity of the models ranged from 89.2% (dengue versus OFI) to 79.6% (DHF versus DF). The models showed high sensitivity in the validation dataset. These models could be used to calculate a probability and classify patients based on readily available clinical laboratory data, and they will need to be validated in other dengue-endemic regions.
MeSH Terms
Adolescent
Algorithms
Child
Child, Preschool
Dengue/classification,diagnosis
Female
Humans
Infant
Male
Multivariate Analysis
Odds Ratio
Physicians
Retrospective Studies
Risk Factors
Sensitivity and Specificity
Severity of Illness Index
World Health Organization
Authors & Affiliations
13 authors, click to expand affiliations / ORCID
Potts James A
Center for Infectious Disease and Vaccine Research and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA. James.Potts@umassmed.edu
Thomas Stephen J
Srikiatkhachorn Anon
Supradish Pra-on
Li Wenjun
Nisalak Ananda
Nimmannitya Suchitra
Endy Timothy P
Libraty Daniel H
Gibbons Robert V
Green Sharone
Rothman Alan L
Kalayanarooj Siripen
References (17)
17 references, click to expand
-
Indian perspective on the need for new case definitions of severe dengue.
Lancet Infect Dis. 2007 Feb;7(2):81-2
PMID: 17251078
-
Clinical spectrum and management of dengue haemorrhagic fever.
Southeast Asian J Trop Med Public Health. 1987 Sep;18(3):392-7
PMID: 3433169
-
Early clinical and laboratory indicators of acute dengue illness.
J Infect Dis. 1997 Aug;176(2):313-21
PMID: 9237695
-
Clinical diagnosis and assessment of severity of confirmed dengue infections in Vietnamese children: is the world health organization classification system helpful?
Am J Trop Med Hyg. 2004 Feb;70(2):172-9
PMID: 14993629
-
Classifying dengue: a review of the difficulties in using the WHO case classification for dengue haemorrhagic fever.
Trop Med Int Health. 2006 Aug;11(8):1238-55
PMID: 16903887
-
Clinical, epidemiologic, and virologic features of dengue in the 1998 epidemic in Nicaragua.
Am J Trop Med Hyg. 2000 Jul-Aug;63(1-2):5-11
PMID: 11357995
-
Dengue disease severity in Indonesian children: an evaluation of the World Health Organization classification system.
BMC Infect Dis. 2007 Mar 26;7:22
PMID: 17386105
-
Evaluation of the World Health Organization standard tourniquet test and a modified tourniquet test in the diagnosis of dengue infection in Viet Nam.
Trop Med Int Health. 2002 Feb;7(2):125-32
PMID: 11841702
-
Dengue hemorrhagic fever: the sensitivity and specificity of the world health organization definition for identification of severe cases of dengue in Thailand, 1994-2005.
Clin Infect Dis. 2010 Apr 15;50(8):1135-43
PMID: 20205587
-
Short report: assessment of the World Health Organization scheme for classification of dengue severity in Nicaragua.
Am J Trop Med Hyg. 2005 Dec;73(6):1059-62
PMID: 16354812
-
The maintenance need for water in parenteral fluid therapy.
Pediatrics. 1957 May;19(5):823-32
PMID: 13431307
-
An enzyme-linked immunosorbent assay to characterize dengue infections where dengue and Japanese encephalitis co-circulate.
Am J Trop Med Hyg. 1989 Apr;40(4):418-27
PMID: 2540664
-
An evaluation of modified case definitions for the detection of dengue hemorrhagic fever. Puerto Rico Association of Epidemiologists.
P R Health Sci J. 1999 Dec;18(4):347-52
PMID: 10730301
-
Hemostatic changes in Vietnamese children with mild dengue correlate with the severity of vascular leakage rather than bleeding.
Am J Trop Med Hyg. 2009 Oct;81(4):638-44
PMID: 19815879
-
Cross-reactive IgM responses in patients with dengue or Japanese encephalitis.
J Clin Virol. 2008 May;42(1):75-7
PMID: 18304870
-
Clinical and laboratory features that distinguish dengue from other febrile illnesses in endemic populations.
Trop Med Int Health. 2008 Nov;13(11):1328-40
PMID: 18803612
-
Severe dengue: the need for new case definitions.
Lancet Infect Dis. 2006 May;6(5):297-302
PMID: 16631550