title: Predictive symptoms and signs of severe dengue disease for patients with dengue fever: a meta-analysis.
abstract: The aim of the meta-analysis was to provide more solid evidence for the reliability of the new classification. A systematic literature search was performed using PubMed, Armed Forces Pest Management Board Literature Retrieval System, and Google Scholar up to August 2012. A pooled odds ratio (OR) was calculated using either a random-effect or a fixed-effect model. A total of 16 papers were identified. Among the 11 factors studied, five symptoms demonstrated an increased risk for SDD, including bleeding [OR: 13.617; 95% confidence interval (CI): 3.281, 56.508], vomiting/nausea (OR: 1.692; 95% CI: 1.256, 2.280), abdominal pain (OR: 2.278; 95% CI: 1.631, 3.182), skin rashes (OR: 2.031; 95% CI: 1.269, 3.250), and hepatomegaly (OR: 4.751; 95% CI: 1.769, 12.570). Among the four bleeding-related symptoms including hematemesis, melena, gum bleeding, and epistaxis, only hematemesis (OR: 6.174; 95% CI: 2.66, 14.334; P < 0.001) and melena (OR: 10.351; 95% CI: 3.065, 34.956; P < 0.001) were significantly associated with SDD. No significant associations with SDD were found for gender, lethargy, retroorbital pain, diarrhea, or tourniquet test, whereas headache appeared protective (OR: 0.555; 95% CI: 0.455, 0.676). The meta-analysis suggests that bleeding (hematemesis/melena), vomiting/nausea, abdominal pain, skin rashes, and hepatomegaly may predict the development of SDD in patients with DF, while headache may predict otherwise.
authors.affiliation: Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China ; Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Higher Institutes, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou 510515, China.
authors.forename: H
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Y P
authors.initials: YP
authors.lastname: Zhou
authors.affiliation: Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Higher Institutes, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou 510515, China.
authors.forename: H J
authors.initials: HJ
authors.lastname: Peng
authors.affiliation: Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
authors.forename: X H
authors.initials: XH
authors.lastname: Zhang
authors.affiliation: Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: F Y
authors.initials: FY
authors.lastname: Zhou
authors.affiliation: Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Z H
authors.initials: ZH
authors.lastname: Liu
authors.affiliation: Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Higher Institutes, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou 510515, China.
authors.forename: X G
authors.initials: XG
authors.lastname: Chen
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis; D003716:Dengue Virus / Q000472:pathogenicity*; D003967:Diarrhea / Q000175:diagnosis / Q000473:pathology; D004196:Disease Outbreaks; D006470:Hemorrhage / Q000175:diagnosis / Q000473:pathology; D006529:Hepatomegaly / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D019595:Severe Dengue / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D014839:Vomiting / Q000175:diagnosis / Q000473:pathology
references.citation: PLoS One. 2010 Jan 14;5(1):e8709
references.pmid: 20090849
references.citation: Clinics (Sao Paulo). 2013 Oct;68(10):1299-304
references.pmid: 24212835
references.citation: Am J Trop Med Hyg. 2001 Dec;65(6):840-7
references.pmid: 11791984
references.citation: Adv Virus Res. 2003;60:421-67
references.pmid: 14689700
references.citation: Trop Med Int Health. 2009 Sep;14(9):1154-9
references.pmid: 19624479
references.citation: PLoS Negl Trop Dis. 2014 Apr 03;8(4):e2777
references.pmid: 24699282
references.citation: Cell Host Microbe. 2010 Feb 18;7(2):128-39
references.pmid: 20153282
references.citation: Acta Med Indones. 2011 Apr;43(2):129-35
references.pmid: 21785176
references.citation: Lancet Infect Dis. 2010 Oct;10(10):712-22
references.pmid: 20883967
references.citation: PLoS Med. 2009 Jul 21;6(7):e1000097
references.pmid: 19621072
references.citation: PLoS Negl Trop Dis. 2012;6(2):e1520
references.pmid: 22389735
references.citation: Am J Trop Med Hyg. 2014 Jan;90(1):169-72
references.pmid: 24218410
references.citation: Am J Trop Med Hyg. 2004 Feb;70(2):172-9
references.pmid: 14993629
references.citation: Am J Epidemiol. 2002 Jul 1;156(1):40-51
references.pmid: 12076887
references.citation: Postgrad Med J. 2004 Oct;80(948):588-601
references.pmid: 15466994
references.citation: Trans R Soc Trop Med Hyg. 2011 Oct;105(10):601-3
references.pmid: 21855101
references.citation: J Infect Dev Ctries. 2012 Jul 23;6(7):551-4
references.pmid: 22842941
references.citation: Arch Pathol Lab Med. 1979 Aug;103(9):463-6
references.pmid: 380510
references.citation: Trends Microbiol. 2003 Sep;11(9):415-21
references.pmid: 13678856
references.citation: Indian Pediatr. 2002 Nov;39(11):1027-33
references.pmid: 12466573
references.citation: PLoS One. 2013 Nov 22;8(11):e81060
references.pmid: 24278377
references.citation: J Pak Med Assoc. 2009 Jun;59(6):339-44
references.pmid: 19534364
references.citation: J Microbiol Immunol Infect. 2006 Apr;39(2):121-9
references.pmid: 16604244
references.citation: J Clin Med Res. 2012 Feb;4(1):33-44
references.pmid: 22383925
references.citation: Am J Trop Med Hyg. 2005 Aug;73(2):435-40
references.pmid: 16103617
references.citation: Trans R Soc Trop Med Hyg. 2007 Nov;101(11):1114-9
references.pmid: 17706259
references.citation: Virol J. 2011 Aug 11;8:398
references.pmid: 21835036
references.citation: QJM. 2006 May;99(5):299-305
references.pmid: 16603571
references.citation: PLoS Negl Trop Dis. 2013 Sep 26;7(9):e2412
references.pmid: 24086778
references.citation: PLoS One. 2010 Sep 13;5(9):e12505
references.pmid: 20856935
references.citation: Kathmandu Univ Med J (KUMJ). 2006 Jan-Mar;4(1):40-3
references.pmid: 18603866
references.citation: Lancet. 1998 Sep 19;352(9132):971-7
references.pmid: 9752834
references.citation: BMJ. 2003 Sep 6;327(7414):557-60
references.pmid: 12958120