A novel predictor of severe dengue: The aspartate aminotransferase/platelet count ratio index (APRI)
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Abstract:
To evaluate risk factors for the development of dengue into severe dengue in Guangdong. A retrospective analysis of clinical data from 212 dengue patients between June and October 2014. A total of 174 (82.1%) patients in our study had classic dengue, of which 38 (17.9%) had severe diseases. The frequencies of jaundice, pleural effusion, ascites, and vaginal bleeding were significantly different between the two groups (P < 0.05). The routine laboratory test results for alanine aminotransferase, aspertate aminotransferase, albumin, leukocyte count, platelet count, activated partial prothrombin time, prothrombin time, and aspartate aminotransferase/platelet count ratio index showed a significant association with severe dengue (P < 0.01). The areas under the receiver operating characteristic curves (AUC) were 0.727 (95% CI 0.662-0.78), 0.699 (95%CI 0.632-0.760), 0.634 (95%CI 0.565-0.698), 0.757 (95%CI 0.694-0.813), 0.775 (95%CI 0.713-0.829), 0.713 (95%CI 0.647-0.773), 0.719 (95%CI 0.730-0.843), and 0.785 (95%CI 0.724-0.893), respectively. The logistic regression analysis identified three factors, including high WBC (OR 1.52), prolonged PT (OR 1.745). and high APRI (OR 1.05) may be associated with the discrimination criteria to identify patients with and without severe diseases. The combination of the three factors (WBC, PT, and APRI) showed better AUC (0.877) and OR (1.52) scores. Our study indicates that laboratory tests such as WBC, PT, and APRI, helped identify patients at risk of developing severe dengue. The APRI was identified as a valuable predictor of patients with severe dengue. Combining the WBC, PT, and APRI scores allowed a better prediction of severe dengue.Keywords:
Prothrombin time
Alanine aminotransferase
This study was performed to find out whether ultrasound is an important adjunct to clinical and laboratory profile in diagnosing dengue fever or dengue haemorrhagic fever and to further determine whether ultrasound is useful in predicting the severity of the disease. Ultrasound was performed on 128 patients (2-9 years) with clinical suspicion of dengue fever. Serological tests were performed to confirm the diagnosis. 40 patients were serologically negative for dengue fever and later excluded from the study. Of the remaining 88 serologically positive cases, 32 patients underwent ultrasound on second to third day, repeated on fifth to seventh day of fever and in 56 patients ultrasound was done only on fifth to seventh day of fever. Of the 32 patients who underwent the study on second to third day of fever, all showed gall bladder wall thickening and pericholecystic fluid, 21% had hepatomegaly, 6.25% had splenomegaly and right minimal pleural effusion. Follow-up ultrasound on fifth to seventh day revealed ascites in 53% left pleural effusion in 22% and pericardial effusion in 28%. Of the 56 patients who underwent the study on fifth to seventh day of fever for the first time all had gall bladder wall thickening, 21% had hepatomegaly, 7% had splenomegaly, 96% had ascites, 87.5% had right pleural effusion, 66% had left pleural effusion and 28.5% had pericardial fluid. To conclude, in an epidemic of dengue, ultrasound features of thickened gall bladder wall, pleural effusion and ascites should strongly favour the diagnosis of dengue fever.
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There are several limitations in diagnosing plasma leakage using the World Health Organization (WHO) guidelines of dengue hemorrhagic fever. We conducted a study to develop a dengue scoring system to predict pleural effusion and/or ascites using routine laboratory parameters. A prospective observational study was carried out at Cipto Mangunkusumo Hospital and Persahabatan Hospital, Jakarta, Indonesia. Dengue-infected adults admitted on the third febrile day from March, 2010 through August, 2015 were included in the study. A multivariate analysis was conducted to determine the independent diagnostic predictors of pleural effusion and/or ascites and to convert the prediction model into a scoring system. A total of 172 dengue-infected adults were enrolled in the study. Of the 172 patients, 101 (58.7 %) developed pleural effusion and/or ascites. A multivariate analysis was conducted to determine the independent diagnostic predictors of pleural effusion and/or ascites in dengue-infected adults. The predictors were scored based on the following calculations: hemoconcentration ≥15.1 % had a score of 1 (OR, 3.11; 95 % CI, 1.41–6.88), lowest albumin concentration at critical phase ≤3.49 mg/dL had a score of 1 (OR, 4.48; 95 % CI, 1.87–10.77), lowest platelet count ≤49,500/μL had a score of 1 (OR, 3.62; 95 % CI, 1.55–8.49), and elevated ratio of AST ≥2.51 had a score of 1 (OR 2.67; 95 % CI, 1.19–5.97). At a cut off of ≥ 2, the Dengue Score predicted pleural effusion and/or ascites diagnosis with positive predictive value of 79.21 % and negative predictive value of 74.63 %. This prediction model is suitable for calibration and good discrimination. We have developed a Dengue Score that could be used to identify pleural effusion and/or ascites and might be useful to stratify dengue-infected patients at risk for developing severe dengue.
Hypoalbuminemia
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Dengue fever and dengue hemorrhagic fever emerged as major health problem in South East Asia and Bangladesh as well. The purpose of this study is to determine the use of ultrasound as an important adjunct to clinical and laboratory profile in diagnosing dengue fever and in predicting the severity of the disease. Sixty serologically diagnosed dengue fever patients between August and October 2019 referred for ultrasound scanning of the abdomen and thorax were selected for the study and the findings were analyzed. Out of the 60 patients, 19 (31.67%) had hepatomegaly, thick walled gall bladder, ascites with bilateral pleural effusion; 15 (25%) had hepatomegaly, thick walled gall bladder, ascites and only right sided pleural effusion; 6 (10%) had hepatomegaly and right sided pleural effusion; 5 (8.35%) had hepatomegaly and ascites; 3 (5%) had thick walled gall bladder; 1 (1.66%) patient had left sided pleural effusion and hepatomegaly; 1 (1.66%) patient had only hepatosplenomegaly; 1 (1.66%) had ascites with pericardial effusion and no abnormal sonographic findings was found in 9 individuals (15%). Ultrasound findings should strongly favor the diagnosis of dengue fever in patients presenting with fever and associated symptoms, particularly during an endemic. A simple ultrasound examination will effectively expedite the diagnosis and justifies initiation of specific treatment for dengue fever pending serological confirmation. Ultrasound also helps substantially in estimating the severity of the disease. Faridpur Med. Coll. J. Jul 2019;14(2): 90-92
Hepatosplenomegaly
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To note ultrasonographic findings used for diagnosing plasma leakage in dengue haemorrhagic fever patients.The observational retrospective study was conducted at the Holy Family Hospital, Rawalpindi and comprised records of patients with confirmed dengue infection who were screened for dengue haemorrhagic fever according to Dengue Expert Advisory Group criteria from July 1 to December 31, 2013. Each patient underwent ultrasonography for the detection of ascites, gall bladder wall thickness, pleural and/or pericardial effusion along with their quantification and localisation.Of the 240 patients, 166(69.2%) were men. The overall mean age was 28.9±12.4 years. Of the total, 215(89.5%) had ultrasonographic abnormalities, suggestive of plasma leakage. Quantification and localisation wise, mild abdominal ascites 68(47.2%), right pleural effusion 82(74.5%) and mild pleural effusion 98(89%) were commonly noted. None had pericardial effusion.Mild ascites and mild right pleural effusion were the commonest pattern of ultrasonographic leak in dengue haemorrhagic fever patients.
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Capillary leak syndrome (CLS) has been described in dengue fever but its exact features have not been clearly defined. We present here the findings in 25 cases of CLS recently seen by us during an outbreak of dengue fever in northern India. Besides fever, body ache and bleeding manifestations, ascites was present in 84% cases, pleural effusion in 76% cases, and both ascites and pleural effusion in 60% of cases. The pleural effusion was right-sided in 52.6% cases, bilateral in 47.4% cases and only left-sided in none of the cases. The fluid accumulation seen was moderate and frequently involved both abdomen and pleural cavity. The fluid rapidly cleared in a week’s time without any specific treatment. These cases can pose considerable diagnostic challenge which is discussed here.
Clearance
Pleural cavity
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Background: Dengue infection is an extremely common infection in tropical countries. It is considered to be prevalent all-round the year. The aim of the study was to analyse the ultrasound features of serologically proven dengue cases. To correlate the platelet count with ultrasound features of dengue.Methods: Study included dengue patients admitted from January 2011 to December 2012. Dengue was diagnosed by IgM antibody test. All patients underwent ultrasound evaluation and platelet count testing.Results: most common finding was ascites in 43 cases (39.8%), splenomegaly in 41 cases (37.9%), right sided pleural effusion in 25 cases (23.4%), gall bladder wall thickening was present in 30 cases (27.7%) and hepatomegaly was present in 20 cases (18.5%). Presence of most of the features of ultrasound evaluation correlated with a platelet count of less than 40000 cells/mm3.Conclusions: The commonest sonographic findings were ascites and splenomegaly followed by pleural effusion and gall bladder wall thickening. Thus, presence of these ultrasound features in a febrile patient may be suggestive of dengue fever and presence of all the sonographic features may suggest a low platelet count.
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Objective
To observe the efficacy of alphrostadil injection on patients with decompensated cirrhosis.
Methods
A toatal of 112 patients with decompensated cirrhosis were selected and randomly divided into treatment group and control group, with 56 cases in each group. The patients in control group were treated with conventional liver protection and support treatment, while the patients in treatment group were given alphrostadil injection on the basis of conventional treatment. The changes of liver function index including alanine aminotransferase(ALT), total bilirubin(TBIL), albumin(ALB), prothrombin cativity(PTA), ascites and complications were compared.
Results
The levels of ALT, TBiL were significant decreased and the levels of ALB, PTA were increased after treatment in both groups(P 0.05).
Conclusions
Alphrostadil can improve the liver function of patients with liver cirrhosis, it had considerable effects on decompensated cirrhosis.
Key words:
Alphrostadil; Liver cirrhosis; Liver function
Liver function
Prothrombin time
Alanine aminotransferase
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Background : The purpose of this study is to evaluate if ultrasonography may be used as an useful addition to clinical and radiology profiles in diagnosing dengue fever and predicting virus severity by comparing imaging findings. The difference in sonographic characteristics observed in patients of various ages was also investigated.
Objective : The goal of this study is to determine role of ultrasound for diagnosis of complications of dengue fever in Gujrat
Materials and Methods: This is a retrospective study. From October and December 2021, 79 patients who were serologically confirmed with dengue fever were referred for ultrasound scanning of the abdomen at Aziz bhatti shaheed hospital Gujrat, and the imaging data were evaluated. The statistical kit for social science (spss) is used for data analysis.
Results: out of 76 positive dengue patients there are 71(89.9%) male and 8(10%) are female .48 (60.8%) patients showed splenomegaly, 24(30%) patients showed ascites in which 8 (10%) have pelvic ascites and 16 (20.3%) abdominal ascites, 63 (79.7%) patients showed edematous GB wall thickening, 21(26.6%) showed pleural effusion while 18 (22.8 %) have bilateral pleural effusion and 3 (3.8%) have right sided.
Conclusion: In patients presenting with fever and concomitant symptoms, sonographic signs of thickening GB wall, pleural effusion (bilateral or right side), ascites, and splenomegaly should strongly help in early diagnosis of dengue fever, especially during an outbreak.
Concomitant
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Background: Many biochemical and hematological changes occur in dengue infection, which is dependent on the clinical disease. The Dengue Score (DS) is a useful tool for anticipating plasma leakage. The platelet count, hematocrit (Hct), aspartate aminotransferase (AST) ratio and albumin is used for it. Aim: To predict a score useful to detect dengue hemorrhagic fever. Method: The study was retrospective observational. It is done in Dengue wards in Ghurki teaching hospital Lahore and Mayo Hospital Lahore. In the study 100 patients record was taken who were admitted from August 2021 to November 2021. A proforma was filled. SPSS 23 was used for statistical analysis of the data. Results: The mean age was 38.32±13.713. Out of 100 patients 57(57%) were male while 43(43%) were female. 32 were included in dengue score (DS) ≤1, 33 were included in dengue score = 2 and 35 were included in dengue score ≥3. Ascites developed in 6 patients with DS ≤1, 24 with DS ═2, 31 with DS ≥3. Pleural effusion developed in 3 with DS ≤1, 20 with DS ═2, 21 with DS ≥3 so It showed significant association of effusion and ascites with DS = 2 and score ≥3. Conclusion: Dengue score can be calculated by change in hemoconcentration, platelets, serum albumin and AST ratio so it can be used to predict plasma leakage which is part of dengue hemorrhagic fever. Keywords: Dengue Score (DS), Plasma Leakage, Pleural effusion, Ascites
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