Early predictors of severe dengue: Clinico-investigative approach

Background: Dengue poses a common conundrum to the emergency care pediatrician regarding the requirement of admission anticipating complications in the critical phase or following the patient on an outpatient basis Objectives: To study the clinical and investigative profile of dengue infection and utility of clinical and investigative parameters as predictive markers for early identification of severe dengue. Method: All hospitalized children satisfying inclusion criteria were studied. Detailed history, examination and relevant investigations were done. Results: Fifty-two patients were studied. Combination of symptoms of nausea/vomiting and a clinical sign, right hypochondriac tenderness had significant correlation with the severity of dengue infection [odds ratio 13.18 (CI 2.48, 69.98), ROC 0.779]. Nausea /vomiting, right hypochondriac pain and deranged liver function tests (LFTs) together had significant correlation with severe dengue infection [Odds ratio 14.14(CI 3.03, 65.99), ROC 0.778]. This combination, occurring at initial presentation, had a sensitivity of 75%, specificity of 82.5%, positive predictive value of 56.3%, and negative predictive value of 91.7 %. Conclusions: Combination of nausea/vomiting with right hypochondriac pain/tenderness together with the addition of deranged LFTs could serve as predictive markers for severe dengue.