Predictive value of simple clinical and laboratory variables for dengue hemorrhagic fever in adults

BackgroundSingapore experienced its worst dengue outbreak in 30 years in 2004, with 9459 notified cases, of which 83% were hospitalized.ObjectivesTo determine predictors of dengue hemorragic fever (DHF) upon first presentation to hospital to aid clinicians in determining need for admission.Study designWe conducted a retrospective cohort study on dengue patients in Tan Tock Seng Hospital, Singapore in 2004, with patients catergorized into dengue fever (DF) and DHF. Demographic, clinical, and laboratory variables upon first presentation were compared to determine the likelihood of developing DHF.ResultsThere were 1973 dengue patients—118 (6.0%) were DHF, of which 82 (4.2%) developed DHF during hospitalization. From the multivariate analysis, patients with bleeding had an odds of developing DHF 237.6 times that of DF, a unit decrease in total protein (g/L) had an odds of 1.28 times, a unit increase in blood urea (mmol/L) had an odds of 1.31 times, and a unit decrease in lymphocyte proportion had an odds of 1.08 times. The model had a sensitivity of 97.6%, specificity of 60.2%, and may reduce 1118 (56.7%) dengue admissions.ConclusionsA few easily available clinical and laboratory results may assist clinicians in determining dengue admissions.