title: Dengue score: a proposed diagnostic predictor for pleural effusion and/or ascites in adults with dengue infection.
abstract: There are several limitations in diagnosing plasma leakage using the World Health Organization (WHO) guidelines of dengue hemorrhagic fever. We conducted a study to develop a dengue scoring system to predict pleural effusion and/or ascites using routine laboratory parameters.
  
  
  
  A prospective observational study was carried out at Cipto Mangunkusumo Hospital and Persahabatan Hospital, Jakarta, Indonesia. Dengue-infected adults admitted on the third febrile day from March, 2010 through August, 2015 were included in the study. A multivariate analysis was conducted to determine the independent diagnostic predictors of pleural effusion and/or ascites and to convert the prediction model into a scoring system.
  
  
  
  A total of 172 dengue-infected adults were enrolled in the study. Of the 172 patients, 101 (58.7 %) developed pleural effusion and/or ascites. A multivariate analysis was conducted to determine the independent diagnostic predictors of pleural effusion and/or ascites in dengue-infected adults. The predictors were scored based on the following calculations: hemoconcentration ≥15.1 % had a score of 1 (OR, 3.11; 95 % CI, 1.41-6.88), lowest albumin concentration at critical phase ≤3.49 mg/dL had a score of 1 (OR, 4.48; 95 % CI, 1.87-10.77), lowest platelet count ≤49,500/μL had a score of 1 (OR, 3.62; 95 % CI, 1.55-8.49), and elevated ratio of AST ≥2.51 had a score of 1 (OR 2.67; 95 % CI, 1.19-5.97). At a cut off of ≥ 2, the Dengue Score predicted pleural effusion and/or ascites diagnosis with positive predictive value of 79.21 % and negative predictive value of 74.63 %. This prediction model is suitable for calibration and good discrimination.
  
  
  
  We have developed a Dengue Score that could be used to identify pleural effusion and/or ascites and might be useful to stratify dengue-infected patients at risk for developing severe dengue.
authors.affiliation: Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta, Indonesia.
authors.forename: Suhendro
authors.initials: S
authors.lastname: Suwarto
authors.affiliation: Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta, Indonesia.
authors.forename: Leonard
authors.initials: L
authors.lastname: Nainggolan
authors.affiliation: Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta, Indonesia.
authors.forename: Robert
authors.initials: R
authors.lastname: Sinto
authors.affiliation: Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia.
authors.forename: Bonita
authors.initials: B
authors.lastname: Effendi
authors.affiliation: Department of Internal Medicine, Persahabatan Hospital, Jakarta, Indonesia.
authors.forename: Eppy
authors.initials: E
authors.lastname: Ibrahim
authors.affiliation: Department of Internal Medicine, Persahabatan Hospital, Jakarta, Indonesia.
authors.forename: Maulana
authors.initials: M
authors.lastname: Suryamin
authors.affiliation: Eijkman Institute of Molecular Biology, Jl. Diponegoro 69, Jakarta, 10430, Indonesia. sasmono@eijkman.go.id.
authors.forename: R Tedjo
authors.identifier: 0000-0003-0986-2590
authors.initials: RT
authors.lastname: Sasmono
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001201:Ascites / Q000000981:diagnostic imaging*; D002648:Child; D005122:Exudates and Transudates; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007214:Indonesia; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010976:Platelet Count; D010996:Pleural Effusion / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000032:analysis; D019595:Severe Dengue / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D006454:Hemoglobins; D012709:Serum Albumin
keywords: AST ratio; Albumin; Ascites; Dengue score; Hematocrit; Platelet; Pleural effusion