title: Risk factors for shock in children with dengue fever.
abstract: OBJECTIVE
  To evaluate and analyze the clinical and laboratory parameters that were predictive of the development of shock in children with dengue fever.
  
  
  METHODS
  Retrospective study carried out from August 2012 to July 2014 at a tertiary care hospital in Puducherry.
  
  
  RESULTS
  Two hundred and fifty-four children were admitted with dengue fever and among them dengue fever without shock was present in 159 children (62.5%) and dengue fever with shock was present in 95 cases (37.4%). Various clinical and laboratory parameters were analyzed using univariate and multivariate logistic regression between the two groups and a P value of <0.05 was taken as significant. The most common risk factors for shock on univariate analysis were headache, retro-orbital pain, palmar erythema, joint pain, facial flush, splenomegaly, lymphadenopathy, bleeding, giddiness, persistent vomiting, pleural effusion, ascites, hematocrit >20% with concomitant platelet count <50,000/mm(3) on admission, deranged liver function tests, and gallbladder wall edema. On multivariate analysis, it was seen that in age >6 years, hepatomegaly, pain in the abdomen, and oliguria were the most common risk factors associated with shock in children with dengue fever. There were six deaths (2.4%) and out of them four presented with impaired consciousness (66.6%) at the time of admission.
  
  
  CONCLUSIONS
  Age >6 years, hepatomegaly, abdomen pain, and oliguria were the most common risk factors for shock in children with dengue fever. Impaired consciousness at admission was the most ominous sign for mortality in dengue fever. Hence, these features should be identified early, monitored closely, and managed timely.
authors.affiliation: Department of Paediatrics, Indira Gandhi Medical College and Research Institute, Puducherry, India.
authors.forename: Sriram
authors.initials: S
authors.lastname: Pothapregada
authors.affiliation: Department of Paediatrics, Indira Gandhi Medical College and Research Institute, Puducherry, India.
authors.forename: Banupriya
authors.initials: B
authors.lastname: Kamalakannan
authors.affiliation: Department of Community Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors.forename: Mahalakshmy
authors.initials: M
authors.lastname: Thulasingham
keywords: Dengue shock syndrome; encephalopathy; risk factors