title: Clinical Manifestations and Predictors of Thrombocytopenia in Hospitalized Adults with Dengue Fever.
abstract: BACKGROUND
  India is one of the seven identified Southeast Asian countries reporting frequent outbreaks of dengue fever (DF).
  
  
  OBJECTIVE
  This study was to analyze clinical and laboratory profile and predictive markers of thrombocytopenia and length of hospital stay in DF.
  
  
  METHODS
  This record-based retrospective study conducted in a coastal district of Karnataka, South India, included all dengue cases in adults aged >18 years, admitted during period of January 2011 to December 2014. Multivariate logistic regression analysis was carried out to compute odds ratio (OR) and 95% confidence interval (CI) to assess independent associations of variables with low platelet count and longer duration of hospital stay.
  
  
  RESULTS
  Among 207 dengue immunoglobulin M (IgM) antibody confirmed cases (mean age of 36.94 ± 14.61 years), 143 (69.1%) were males and 64 were females. The mean duration of illness and hospital stay were 4.94 ± 3.58 days and 5.98 ± 2.58 days, respectively. Abdominal symptoms included nausea and vomiting (53.6%), abdominal pain (25.1%), and diarrhea (13.5%). Bleeding manifestations were seen in 24 (11.6%) cases and fluid accumulation was revealed in 18 (8.7%) cases. The mean platelet count was 110,159.42 ± 68,397.32 (cells/mm(3)). Low platelet count on admission was associated with the presence of rash (OR = 0.43, 95% CI 0.23-0.81), high aspartate aminotransferase (AST) levels (OR = 3.14, 95% CI 1.58-6.23), high alanine aminotransferase (ALT) levels (OR = 2.91, 95% CI 1.55-5.47), and low albumin levels (OR = 4.48, 95% CI 1.02-19.75). The duration of hospital stay was associated with diarrhea (OR = 0.4, 95% CI 0.18-0.9), abdominal pain (OR = 0.52, 95% CI 0.27-1.00), ascites (OR = 0.26, 95% CI 0.09-0.69), and low hemoglobin (OR = 0.46, 95% CI 0.25-0.86) level on admission.
  
  
  CONCLUSIONS
  Though thrombocytopenia on admission was associated with the presence of rash, high AST and ALT levels, and low albumin levels, it was not predictive of length of hospitalization. Duration of hospital stay was longer with the presence of diarrhea, abdominal pain, ascites, and low hemoglobin level on admission.
authors.affiliation: Department of General Medicine, KS Hegde Medical Academy, Mangaluru, Karnataka, India.
authors.forename: Akshatha Rao
authors.initials: AR
authors.lastname: Aroor
authors.affiliation: Department of Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors.forename: Rama Prakasha
authors.initials: RP
authors.lastname: Saya
authors.affiliation: Department of Pharmacology, Pondicherry Institute of Medical Sciences, Puducherry, India.
authors.forename: Ajitha
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of General Medicine, KS Hegde Medical Academy, Mangaluru, Karnataka, India.
authors.forename: Anuroop
authors.initials: A
authors.lastname: Venkatesh
authors.affiliation: Department of General Medicine, KS Hegde Medical Academy, Mangaluru, Karnataka, India.
authors.forename: Rhea
authors.initials: R
authors.lastname: Alva
keywords: Dengue fever; profile; thrombocytopenia