title: Evaluation of the WHO revised criteria for classification of clinical disease severity in acute adult dengue infection.
abstract: BACKGROUND
  The WHO guidelines were revised recently to identify patients with severe dengue (SD) early. We proceeded to determine the usefulness of the warning signs in the new WHO guidelines in predicting SD and we have also attempted to define other simple laboratory parameters that could be useful in predicting SD.
  
  
  METHODS
  Clinical and laboratory parameters were recorded in 184 patients in 2011, with confirmed dengue viral infections, admitted to a medical ward in two tertiary care hospitals in Colombo, Sri Lanka.
  
  
  RESULTS
  We found that the presence of 5 or more dengue warning signs were significantly (p=0.02) associated with the development of SD (odds ratio 5.14, 95% CI=1.312 to 20.16). The AST levels were significantly higher (p=0.0001) in patients with abdominal pain (mean 243.5, SD ± 200.7), when compared to those who did not have abdominal pain (mean 148.5, SD ± 218.6). Lymphocyte counts <1,500 cells/mm(3) were significantly (p=0.005) associated with SD (odds ratio 3.367, 95% CI 1.396 to 8.123). High AST levels were also significantly associated (p<0.0001) with SD (odds ratio 27.26, 95% CI 1.632 to 455.2). Platelet counts <20,000 cells/mm(3), were again significantly associated (p<0.001) with severe disease (odds ratio 1.632 to 455.2, 95% CI 3.089 to 14.71). The PCR was positive in 26/84 of the patients and we found that the infecting serotype was DEN-1 in all 26 patients.
  
  
  CONCLUSIONS
  The presence of 5 or more warning signs appears to be a predictor of SD. Lymphocyte counts <1,500 cells/mm(3), platelet counts <20,000/mm(3) and raised AST levels were associated with SD and could be used to help identify patients who are likely to develop SD.
authors.affiliation: Department of Medicine, University of Sri Jayawardanapura, Nugegoda, Sri Lanka.
authors.forename: S D
authors.initials: SD
authors.lastname: Jayaratne
authors.forename: Vajini
authors.initials: V
authors.lastname: Atukorale
authors.forename: Laksiri
authors.initials: L
authors.lastname: Gomes
authors.forename: Thashi
authors.initials: T
authors.lastname: Chang
authors.forename: Tharindu
authors.initials: T
authors.lastname: Wijesinghe
authors.forename: Sachie
authors.initials: S
authors.lastname: Fernando
authors.forename: Graham S
authors.initials: GS
authors.lastname: Ogg
authors.forename: Gathsaurie Neelika
authors.initials: GN
authors.lastname: Malavige
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D003715:Dengue / Q000097:blood / Q000145:classification / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D003716:Dengue Virus / Q000235:genetics; D042241:Early Diagnosis; D006801:Humans; D018655:Lymphocyte Count; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission; D010976:Platelet Count; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D012720:Severity of Illness Index; D013188:Sri Lanka; D062606:Tertiary Care Centers; D015854:Up-Regulation; D014944:World Health Organization; D055815:Young Adult
chemical_list: D015415:Biomarkers; D012367:RNA, Viral; D001219:Aspartate Aminotransferases