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01.12.2015 | Research article | Ausgabe 1/2016 Open Access

BMC Infectious Diseases 1/2016

Diagnostic accuracy of peripheral venous lactate and the 2009 WHO warning signs for identifying severe dengue in Thai adults: a prospective observational study

Zeitschrift:
BMC Infectious Diseases > Ausgabe 1/2016
Autoren:
Vipa Thanachartwet, Anan Wattanathum, Nittha Oer-areemitr, Akanitt Jittmittraphap, Duangjai Sahassananda, Chalida Monpassorn, Manoon Surabotsophon, Varunee Desakorn
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

VT contributed to the conception, study design, data collection, data analysis, data interpretation, and with writing and preparing the manuscript. AW contributed to the conception, study design, data interpretation and with writing and preparing the manuscript. NO contributed to the data collection, data analysis, data interpretation, and writing and preparing the manuscript. DS contributed to the data collection, data analysis, graphics preparation for the manuscript, and writing and preparing the manuscript. AJ contributed by assisting with testing for dengue diagnosis, and with writing and preparing the manuscript. CM contributed to caring for patients with dengue. MS contributed to the management and care of critically ill dengue patients and with writing and preparing the manuscript. VD contributed to the conception, study design, data collection, data analysis, data interpretation, and writing and preparation of the manuscript. All authors have provided their final approval of the version to be published and agree to be accountable for all aspects of the work.

Abstract

Background

Dengue is the most common mosquito-borne viral disease in humans. However, the sensitivities of warning signs (WSs) for identifying severe dengue in adults are low, and the utility of lactate levels for identifying severe dengue in adults has not been verified. Therefore, we aimed to evaluate the diagnostic accuracy of using peripheral venous lactate levels (PVL), as well as WSs established by the World Health Organization, for identifying severe dengue.

Methods

We prospectively evaluated individuals hospitalized for dengue who were admitted to the Hospital for Tropical Diseases in Thailand between May 2013 and January 2015. Blood samples to evaluate PVL levels were collected at admission and every 24 h until the patient exhibited a body temperature of <37.8 °C for at least 24 h. Data were recorded on a pre-defined case report form, including baseline characteristics, clinical parameters, and laboratory findings.

Results

Among 125 patients with confirmed dengue, 105 (84.0 %) patients had non-severe dengue, and 20 (16.0 %) patients had severe dengue. The presence of clinical fluid accumulation as a WS provided high sensitivity (75.0 %, 95 % confidence interval [CI]: 50.9–91.3 %) and specificity (90.5 %, 95 % CI: 83.2–95.3 %). The PVL level at admission was used to evaluate its diagnostic value, and receiver operating characteristic curve analysis revealed an area under the curve of 0.84 for identifying severe dengue. At the optimal cutoff value (PVL: 2.5 mmol/L), the sensitivity and specificity were 65.0 % (95 % CI: 40.8–84.6 %) and 96.2 % (95 % CI: 90.5–99.0 %), respectively. A combined biomarker comprising clinical fluid accumulation and/or PVL of ≥2.5 mmol/L provided the maximum diagnostic accuracy for identifying severe dengue, with a sensitivity of 90.0 % (95 % CI: 68.3–98.8 %) and a specificity of 87.6 % (95 % CI: 79.8–93.2 %).

Conclusions

Clinical fluid accumulation and/or PVL may be used as a diagnostic biomarker of severe dengue among adults. This biomarker may facilitate early recognition and timely treatment of patients with severe dengue, which may reduce dengue-related mortality and hospital burden.
Literatur
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