Prediction of plasma leakage phase of dengue in resource limited settings

Abstract Introduction The pathophysiology of severe dengue is related to increased capillary permeability and plasma leakage into extracellular space. A simple, low cost risk prediction tool for plasma leakage will be useful for clinicians practicing in rural areas without imaging facilities. Study design A prospective observational study was carried out over 12 months at the National Hospital, Sri Lanka enrolling patients with confirmed diagnosis (via NS1 antigen testing) of early dengue infection. Clinical features on admission and investigation results on D3, D5 and D7 of the illness were recorded. Evidence of plasma leakage was confirmed by ultrasonography. Results A total of 179 patients met the inclusion criteria (males; 91, 50.8%, mean age: 31.6 years, SD ± 14.7). Sixty seven patients (67/173, 38.7%) had ultrasonographic evidence of plasma leakage. Several clinical features (severe vomiting, severe diarrhoea, abdominal pain and liver tenderness) as well as mean differences of some investigations were significantly associated with progression to plasma leakage. However, only liver tenderness on day 3 emerged as independent significant predictors of critical phase in the adjusted analysis (specificity: 93%, sensitivity: 44%). Conclusions Having liver tenderness by day 3 of the illness is helpful to identify a subgroup of patients at risk of plasma leakage.