Prothrombin Time Prolongation was the Most Important Indicator of Severe Bleeding in Children with Severe Dengue Viral Infection.
To determine the indicators of severe bleeding in children with severe dengue viral infection (DVI), the medical records of patients aged <15 years admitted to Songklanagarind Hospital in southern Thailand during 1989-2011 were reviewed. Severe-bleeding DVI was defined as needing blood products transfusion owing to DVI-caused bleeding. Of the 238 children with severe DVI according to the World Health Organization 2009 criteria, 44 (18.5%) had severe bleeding, of whom 28 (63.6%) died. The international normalized ratio (INR) had high correlations with both transaminase enzymes (Spearman correlation, rs = 0.67-0.69, p <0.01). Multivariate analysis found that patients who had dengue haemorrhagic fever (DHF) grade IV, platelets <20 000/mm3 and INR ≥ 1.5 had increased risk of severe bleeding with odds ratios (95% confidence intervals) of 3.4 (1.4, 8.6), 2.6 (1.1, 6.2) and 10.6 (4.0, 28.4), respectively. Blood products should be at hand in severe DHF children with high risk of severe bleeding.
Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Kamolwish
K
Laoprasopwattana
Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Jehrabeeyah
J
Binsaai
Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Pornpimol
P
Pruekprasert
Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Alan
A
Geater
D002648:Child; D002675:Child, Preschool; D003716:Dengue Virus / Q000302:isolation & purification*; D005260:Female; D005342:Fibrinolysis / Q000502:physiology*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007223:Infant; D008111:Liver Function Tests; D008297:Male; D011517:Prothrombin Time; D012189:Retrospective Studies; D012307:Risk Factors; D019595:Severe Dengue / Q000097:blood / Q000175:diagnosis* / Q000821:virology; D013785:Thailand; D013917:Thrombin / Q000096:biosynthesis* / Q000378:metabolism
D013917:Thrombin
acute liver failure; dengue haemorrhagic fever; prothrombin time prolongation thrombocytopenia; severe bleeding