Predictors of spontaneous bleeding in patients with acute febrile syndrome from a dengue endemic area.
BACKGROUND
Spontaneous bleeding is a common complication of dengue and is associated with an increased mortality.


OBJECTIVE
To evaluate early clinical manifestations and simple laboratory tests as predictors of spontaneous hemorrhage in patients with forms of acute febrile syndrome (AFS) such as dengue from an endemic area.


METHODS
A prospective cohort study was performed including 729 non-bleeding AFS patients who were enrolled during the first 4 days of disease. Basal evaluation included anamnesis, physical examination and complete blood cell count. Follow-up was extended at least until the sixth day of disease. Dengue infection was studied with paired serologic tests and viral isolation. Potential predictors of spontaneous bleeding were evaluated with bivariate and multivariate analysis.


RESULTS
Incidence of outcome was not significantly different between the dengue group and those with non-dengue AFS. The tourniquet test was not associated with outcome (p=0.38). In a binomial regression model, the following variables were associated with outcome: age between 12 and 45 years (RR=2.22; 95% CI: 1.25-3.94), rash (RR=1.66; 95% CI: 1.25-2.2), vomiting (RR=1.46; 95% CI: 1.16-1.83), temperature >38 degrees C (RR=2.63; 95% CI: 1.6-4.33), leukocyte count <4500/microL (RR=1.87; 95% CI: 1.19-2.96), and platelet count <90.000/microL (RR=1.8; 95% CI: 1.1-2.94). With these variables a risk score was formulated that showed an area under ROC curve of 70.5% (95% CI: 64.9-76.2) to predict spontaneous bleeding. The score was useful for predicting bleeding in both dengue and non-dengue AFS groups.


CONCLUSIONS
Some variables evaluated in the first days of disease helped to predict the risk of spontaneous bleeding in patients with dengue and non-dengue AFS.
Diaz-Quijano
Fredi Alexander
FA
Grupo de Epidemiología Clínica, Centro de Investigaciones Epidemiológicas, Universidad Industrial de Santander (UIS), Bucaramanga, Colombia. fre_diazq@yahoo.com
Villar-Centeno
Luis Angel
LA
Martinez-Vega
Ruth Aralí
RA
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003105:Colombia / Q000453:epidemiology; D003715:Dengue / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D019353:Endemic Diseases; D005076:Exanthema / Q000150:complications; D005260:Female; D005334:Fever / Q000150:complications*; D006470:Hemorrhage / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D012306:Risk; D019595:Severe Dengue / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D013577:Syndrome; D014839:Vomiting / Q000150:complications; D055815:Young Adult