title: Development of clinical decision rules to predict recurrent shock in dengue.
abstract: BACKGROUND
  Mortality from dengue infection is mostly due to shock. Among dengue patients with shock, approximately 30% have recurrent shock that requires a treatment change. Here, we report development of a clinical rule for use during a patient's first shock episode to predict a recurrent shock episode.
  
  
  METHODS
  The study was conducted in Center for Preventive Medicine in Vinh Long province and the Children's Hospital No. 2 in Ho Chi Minh City, Vietnam. We included 444 dengue patients with shock, 126 of whom had recurrent shock (28%). Univariate and multivariate analyses and a preprocessing method were used to evaluate and select 14 clinical and laboratory signs recorded at shock onset. Five variables (admission day, purpura/ecchymosis, ascites/pleural effusion, blood platelet count and pulse pressure) were finally trained and validated by a 10-fold validation strategy with 10 times of repetition, using a logistic regression model.
  
  
  RESULTS
  The results showed that shorter admission day (fewer days prior to admission), purpura/ecchymosis, ascites/pleural effusion, low platelet count and narrow pulse pressure were independently associated with recurrent shock. Our logistic prediction model was capable of predicting recurrent shock when compared to the null method (P < 0.05) and was not outperformed by other prediction models. Our final scoring rule provided relatively good accuracy (AUC, 0.73; sensitivity and specificity, 68%). Score points derived from the logistic prediction model revealed identical accuracy with AUCs at 0.73. Using a cutoff value greater than -154.5, our simple scoring rule showed a sensitivity of 68.3% and a specificity of 68.2%.
  
  
  CONCLUSIONS
  Our simple clinical rule is not to replace clinical judgment, but to help clinicians predict recurrent shock during a patient's first dengue shock episode.
authors.forename: Nguyen Tien
authors.initials: NT
authors.lastname: Huy
authors.forename: Nguyen Thanh Hong
authors.initials: NT
authors.lastname: Thao
authors.forename: Tran Thi Ngoc
authors.initials: TT
authors.lastname: Ha
authors.forename: Nguyen Thi Phuong
authors.initials: NT
authors.lastname: Lan
authors.forename: Phan Thi Thanh
authors.initials: PT
authors.lastname: Nga
authors.forename: Tran Thi
authors.initials: TT
authors.lastname: Thuy
authors.forename: Ha Manh
authors.initials: HM
authors.lastname: Tuan
authors.forename: Cao Thi Phi
authors.initials: CT
authors.lastname: Nga
authors.forename: Vo Van
authors.initials: VV
authors.lastname: Tuong
authors.forename: Tran Van
authors.initials: TV
authors.lastname: Dat
authors.forename: Vu Thi Que
authors.initials: VT
authors.lastname: Huong
authors.forename: Juntra
authors.initials: J
authors.lastname: Karbwang
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirayama
mesh_terms: D001201:Ascites / Q000209:etiology; D003661:Decision Support Techniques; D003715:Dengue / Q000150:complications*; D004438:Ecchymosis / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D010976:Platelet Count; D010996:Pleural Effusion / Q000209:etiology; D011674:Pulse; D011693:Purpura / Q000209:etiology; D012008:Recurrence; D012769:Shock / Q000175:diagnosis / Q000209:etiology*; D013997:Time Factors