[Early indicators of severity in dengue virus infection].
OBJECTIVE
To identify clinical markers of severity in dengue, different from those of major hemorrhage.


METHODS
Cross-sectional study.


METHODS
Patients with a diagnosis of dengue infection admitted to hospitals in Santander (Colombia) during the years 1993 to 1998 were studied. On admittance or during hospitalization, patients were classified as cases of dengue hemorrhagic fever (DHF) or dengue fever (DF). Clinical findings differing from those of major hemorrhage were recorded in the emergency room and during the first assessment at hospitalization. The association between these findings and the outcome of DHF were evaluated using univariate and multivariate analyses.


RESULTS
891 patients (DF: 420; DHF: 471) were included in the study. Associations were found between DHF and the following signs and symptoms: vomiting (OR: 1.89; 95% CI: 1.37-2.6; p = 0.0001); gingival hemorrhage (OR: 1.55; 95% CI: 1.11-2.18; p = 0.01); epistaxis (OR: 1.78; 95% CI: 1.28-2.48; p = 0.001); hepatomegaly (OR: 2.56; 95% CI: 1.61-4.07; p < 0.0001); microscopic hematuria (OR: 2.33; 95% CI: 1.36-4; p = 0.002); and rash (OR: 1.36; 95% CI: 1.04-1.77; p = 0.02). The hematocrit in the emergency room and on the first day of hospitalization was significantly higher in the group with DHF (p < 0.001, in both observations). On multivariate analysis, the hematocrit from DHF patients obtained in the emergency room was higher than that from DF, independently of the other relevant variables (difference: 3.65; 95% CI: 2.81-4.49).


CONCLUSIONS
Under the study conditions, there was an association between early clinical findings and DHF. These results must be evaluated in a cohort study.
Díaz-Quijano
Fredi Alexander
FA
Centro de Investigaciones Epidemiológicas, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia. fre_diazq@yahoo.com
Martínez-Vega
Ruth Aralí
RA
Villar-Centeno
Luis Angel
LA
D000293:Adolescent; D000328:Adult; D002648:Child; D003430:Cross-Sectional Studies; D003715:Dengue / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D042241:Early Diagnosis; D005076:Exanthema / Q000209:etiology; D005260:Female; D006400:Hematocrit; D006470:Hemorrhage / Q000209:etiology; D006529:Hepatomegaly / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D010976:Platelet Count; D019595:Severe Dengue / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D012720:Severity of Illness Index; D014839:Vomiting / Q000209:etiology