BACKGROUND: Despite extensive studies on dengue fever, there is still limited knowledge about factors associated with poor outcomes in cases of dengue fever. The shock index (SI) is a bedside tool previously used in the adult population, adopted as a marker for poor outcomes in many shock states. There are limited studies applying the SI in children. There are also no known local studies applying an age-adjusted version as a marker or predictor of poor outcomes in severe acute illness, such as dengue.

OBJECTIVES: To determine the diagnostic ability of the age-adjusted pediatric shock index in predicting outcomes in cases of dengue admitted at a tertiary children's hospital.

METHODS: This is a prospective cohort study performed in a pediatric tertiary hospital over a period of 30 days. Admitting heart rate (HR) and systolic blood pressure (SBP) were taken to determine their shock index. This was then grouped according to age groups based on known literature and corresponding acceptable age-adjusted shock indices (ASI), and compared with outcomes such as final dengue classification (non-severe vs severe), use of inotropes, and mortality.

RESULTS: A total of 90 patients were identified for the study. Three were excluded due to exclusion criteria. 87 cases were followed up after admission from the ER. Unadjusted Shock Index (USI) was found not to be associated with both final dengue classification (as severe dengue) and use of inotropic support. In contrast, ASI was associated with both final dengue classification (p < 0.001) and use of inotropes (p < 0.039). The ASI had a fairly accurate capability of predicting poor outcomes for both final dengue classifications, with an area under the ROC curve of 0.7122, and eventual use of inotropes, with an area under the ROC curve of 0.6435.

CONCLUSIONS AND RECOMMENDATIONS: SI was found to be a helpful tool in predicting poor outcomes, but only when the Age-adjusted Shock Index (ASI) was used. A longer data collection period is recommended to be able to include mortality as an outcome. The predictive value of the tool can be tested against various other markers of poor outcome to widen the application of this non-invasive measure of hemodynamic status.

Human ; Male ; Female ; Pre-adolescent (a Child 6-12 Years Of Age) ; Child Preschool (a Child Between The Ages Of 2 And 5) ; Dengue

BACKGROUND: Severe dengue is a leading cause of serious illness and death, and intensive supportive care is the most important aspect of management. Before fluid resuscitation, a baseline hematocrit is obtained, and frequent monitoring of the complete blood count is needed.

OBJECTIVE: To determine the correlation of ultrasound measurement of inferior vena cava (IVC) to aorta (Ao) diameter ratio with hematocrit levels and severity of shock among children with dengue fever.

METHODOLOGY: This is a prospective study design conducted at the Emergency Room of Philippine Children's Medical Center. Clinical data and hematocrit of the children with dengue fever aged 1 month to 17 years and 364 days old were documented. The Inferior vena cava diameter (IVC)and the Aorta (Ao) diameter ratio was determined using bedside ultrasound.

 RESULTS: The IVC/Ao diameter ratio correlates with high hematocrit and dengue shock in children. There is a significantly higher proportion of subjects with a hematocrit of normal range of age among those with a ratio 1.0.  A ratio of severity of Dengue illness. Sensitivity of IVC/Ao diameter ratio of Measurement of IVC/Ao diameter ratio has high interrater and intrarater reliability.

CONCLUSION AND RECOMMENDATION: IVC/Ao diameter ratio was significantly associated with severity of dengue illness. It should be used to aid decision?making and monitor response to treatments in dengue fever.

Human ; Male ; Female ; Dengue ; Hematocrit ; Diagnostic Imaging ; Vena Cava, Inferior

BACKGROUND: At PCMC, acetated isotonic electrolyte solution is used in the initial resuscitation in severe dengue patients. However, no local study has comparedacetated isotonic electrolyte solution against normal saline and lactated Ringer’s solutions. OBJECTIVE: This study aims to determine the comparative recovery time to achieve initial and sustained cardiovascular stability in severe dengue patients using acetated isotonic electrolyte solution, normal saline solution, and lactated Ringer’s solution. METHODOLOGY: This is a retrospective cohort study involving 166 severe dengue patients 1 month to 18 years old admitted at the PICU from 2014 to 2016. They were divided into 3 groups based on the initial fluid used: 58 in the AIES group, 58 in the NSS group, and 50 in the LRS group. RESULTS: AIES group had the shortest time to achieve initial and sustained stability among patients without re-shock. Also, AIES group needed less fluid to establish stability and had less re-shock, less use of colloid and inotropes, less blood transfusion,and less need for mechanical ventilation and dialysis. NSS had the most fluid shift to AIES and/or colloid while LRS had the most colloid used. Hyperchloremic metabolic acidosis was mostly seen in the NSS group. The length of ICU stay was almost the same in all groups. There was zero mortality in AIES group as compared to 3 on NSS group and 2 in LRS group. CONCLUSION AND RECOMMENDATION Acetated isotonic electrolyte solution is more effectivethan normal saline and lactated Ringer’s solutions in initial fluid resuscitation among severe dengue patients. It should be the fluid of choice in the initial resuscitation among severe dengue patients. It is recommended that a randomized control study with more patients be conducted.
Dengue