Clinical risk factors for dengue shock syndrome in children
Keywords:
dengue hemorrhagic fever, dengue shock syndrome, risk factors
Abstract
Background Dengue shock syndrome (DSS) is a seriouscomplication of dengue hemorrhagic fever (DHF) which may
cause death in more than 50% cases if not treated properly and
promptly. Clinical, viral, and epidemiological risk factors
determine the occurrence of DSS. Identifying risk factors for the
development of shock in patients with DHF can increase the
awareness of clinicians to perform a close monitoring.
Objective To determine the clinical risk factors for DSS.
Methods This case control study was conducted on DHF and
DSS patients admitted to the Department of Child Health,
Medical School, University of Padjadjaran, Dr. Hasan Sadikin
Hospital Bandung from January 2004 to December 2005. The
subjects were patients aged less than 14 years who fulfilled WHO
criteria (1997). The exclusion criteria were history of asthma,
diabetes mellitus, sickle cell anemia, typhoid, sepsis, and measles.
The risk factors for DSS were analyzed using chi-square test,
calculation of odds ratio, and logistic regression analysis.
Results Of 1,404 patients with suspected DHF, 600 met the study
criteria; 200 patients of DSS and 400 patients of DHF as control
group were identified. Univariate analysis showed that there was
association between DSS and age 5-9 years (OR=1.67, 95%CI
1.08;2.58), overweight (OR=1.88, 95%CI 1.22;2.90), vomiting
(OR=1.44, 95%CI 1.02;2.04), abdominal pain (OR=2.07,
95%CI 1.46;2.92), and severe bleeding (OR=13.6, 95%CI
5.96;31.03). By logistic regression analysis, it was found that age
5-9 years (OR=1.62, 95%CI=1.03–2.53), overweight (OR=1.97,
95%CI=1.29–3.08), and persistent abdominal pain (OR=2.08,
95%CI =1.44–2.99) were independent risk factors for DSS.
Conclusion Age 5-9 years, overweight, and persistent abdominal
pain are the risk factors for DSS.
References
1. Hadinegoro SR, Purwanto SH, Chatab F. DSS: Clinical
manifestations, management and outcome. A hospital based
study in Jakarta, Indonesia. Dengue Bulletin WHO 1999;23:12.
2. Price DD, Wilson SR. Dengue fever. cited 2004 Oct 10. avail-
able from: url: http://www.emedicine.com.
3. Russell PK, Chumsermpadetsuk C, Piyaratn P. A fatal case
of dengue hemorrhagic fever in an American child. Pediat-
rics 1967;40:8.
4. Gubler DJ. Dengue and dengue hemorrhagic fever. Clin
Microbiol Rev 1998;11:480-96.
5. Guha-Sapir D, Schimmer B. Dengue. Emerg Themes in Epid.
cited 2005 July 30. available from: url: http://www.ete-
online.com/content/2/1/1.
6. WHO. Dengue haemorrhagic fever: diagnosis, treatment,
prevention and control. 2 nd ed. Geneva: WHO; 1997.
7. Torres JR, Torres CG. Dengue in Latin America. Dengue
Bulletin 2002;26:62-9.
8. Malavige GN, Fernando S, Fernando DJ, Seneviratne SL.
Dengue viral infections. Postgrad Med J 2004; 80:588-601.
9. Bravo JR, Guzman MG, Kaori GP. Why dengue haemorrhagic
fever in Cuba ? Individual risk factors for dengue haemorrhagic
fever/dengue shock syndrome (DHF/DSS). Trans Roy Soc Trop
Med Hyg 1987;81:816-20.
10. Guzman MG, Kouri G. Dengue: an up date. Lancet Infect
Dis 2002;2:33-42.
11. Rigau-Perez JG, Clark GG, Gubler DJ, Reiter P, Sander EJ,
Vorndam AV. Dengue and dengue hemorrhagic fever. Lan-
cet 1998;352:971-7.
12. CDC. Dengue: clinical and public health aspects. Cited 2005
oct 20. available from: url: http://www.cdc.gov/ncidod/dvbid/
dengue/slide 11.htm.
13. Thein S, Aung MM, Shwe TN, Aye M, Zaw A, Aye K, et al.
Risk factor in dengue shock syndrome. Am J Trop Med Hyg
1997;56:566-72.
14. Huang YH, Lei HY, Liu HS, Lin YS, Yeh TM. Dengue virus
infects human endothelial cells and induces IL-6 and IL-8
production. Am J Trop Med Hyg 2000;63:71-5.
15. Phuong CXT, Nhan NT, Kneen R, Thuy TT, Solomon T,
Stepniewska K, et al. Clinical diagnosis and assessment of
severity of confirmed dengue infections in Vietnmese chil-
dren: Is the world health organization classification system
helpful?. Am J Med Hyg 2004;7:172-9.
16. Kalayanarooj S, Nimmannitya S. Is dengue severity related
to related to nutritional status?. Southeast Asian J Trop Med
and Public Health 2005;36:378-84.
17. Baratawidjaja GK. Imunologi dasar. 4 th ed. Jakarta: Fakultas
Kedokteran Universitas Indonesia; 2000.
18. Feigin RD, Stephenson LA. Interaction of infection and nu-
trition. In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL,
editors. Textbook of pediatric infectious diseases. 5 th ed. Phila-
delphia: Saunders; 2004. p. 78-100.
19. Suparyatha IBG, Arhana BNP. The predictors of shock of
dengue hemorrhagic fever. In: Santoso H, Suwendra P,
Suparyatha IBG, editors. 12 th National Congress of Child
Health; Bali, Indonesia; 2000. p. 174.
20. Ditch EA. Role of the gut in multiple organ dysfunction syn-
drome. Cited on 22 November 2005 available from: url: http:/
/www.theuniversityhospital.com/trauma/pdf/gut.
21. Espinosa JN, Dantes HG, Quintal JGC, Martinez JLV. Clini-
cal profile of dengue hemorrhagic fever cases in Mexico. Salud
Publica de Mexico 2005; 47:193-200.
manifestations, management and outcome. A hospital based
study in Jakarta, Indonesia. Dengue Bulletin WHO 1999;23:12.
2. Price DD, Wilson SR. Dengue fever. cited 2004 Oct 10. avail-
able from: url: http://www.emedicine.com.
3. Russell PK, Chumsermpadetsuk C, Piyaratn P. A fatal case
of dengue hemorrhagic fever in an American child. Pediat-
rics 1967;40:8.
4. Gubler DJ. Dengue and dengue hemorrhagic fever. Clin
Microbiol Rev 1998;11:480-96.
5. Guha-Sapir D, Schimmer B. Dengue. Emerg Themes in Epid.
cited 2005 July 30. available from: url: http://www.ete-
online.com/content/2/1/1.
6. WHO. Dengue haemorrhagic fever: diagnosis, treatment,
prevention and control. 2 nd ed. Geneva: WHO; 1997.
7. Torres JR, Torres CG. Dengue in Latin America. Dengue
Bulletin 2002;26:62-9.
8. Malavige GN, Fernando S, Fernando DJ, Seneviratne SL.
Dengue viral infections. Postgrad Med J 2004; 80:588-601.
9. Bravo JR, Guzman MG, Kaori GP. Why dengue haemorrhagic
fever in Cuba ? Individual risk factors for dengue haemorrhagic
fever/dengue shock syndrome (DHF/DSS). Trans Roy Soc Trop
Med Hyg 1987;81:816-20.
10. Guzman MG, Kouri G. Dengue: an up date. Lancet Infect
Dis 2002;2:33-42.
11. Rigau-Perez JG, Clark GG, Gubler DJ, Reiter P, Sander EJ,
Vorndam AV. Dengue and dengue hemorrhagic fever. Lan-
cet 1998;352:971-7.
12. CDC. Dengue: clinical and public health aspects. Cited 2005
oct 20. available from: url: http://www.cdc.gov/ncidod/dvbid/
dengue/slide 11.htm.
13. Thein S, Aung MM, Shwe TN, Aye M, Zaw A, Aye K, et al.
Risk factor in dengue shock syndrome. Am J Trop Med Hyg
1997;56:566-72.
14. Huang YH, Lei HY, Liu HS, Lin YS, Yeh TM. Dengue virus
infects human endothelial cells and induces IL-6 and IL-8
production. Am J Trop Med Hyg 2000;63:71-5.
15. Phuong CXT, Nhan NT, Kneen R, Thuy TT, Solomon T,
Stepniewska K, et al. Clinical diagnosis and assessment of
severity of confirmed dengue infections in Vietnmese chil-
dren: Is the world health organization classification system
helpful?. Am J Med Hyg 2004;7:172-9.
16. Kalayanarooj S, Nimmannitya S. Is dengue severity related
to related to nutritional status?. Southeast Asian J Trop Med
and Public Health 2005;36:378-84.
17. Baratawidjaja GK. Imunologi dasar. 4 th ed. Jakarta: Fakultas
Kedokteran Universitas Indonesia; 2000.
18. Feigin RD, Stephenson LA. Interaction of infection and nu-
trition. In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL,
editors. Textbook of pediatric infectious diseases. 5 th ed. Phila-
delphia: Saunders; 2004. p. 78-100.
19. Suparyatha IBG, Arhana BNP. The predictors of shock of
dengue hemorrhagic fever. In: Santoso H, Suwendra P,
Suparyatha IBG, editors. 12 th National Congress of Child
Health; Bali, Indonesia; 2000. p. 174.
20. Ditch EA. Role of the gut in multiple organ dysfunction syn-
drome. Cited on 22 November 2005 available from: url: http:/
/www.theuniversityhospital.com/trauma/pdf/gut.
21. Espinosa JN, Dantes HG, Quintal JGC, Martinez JLV. Clini-
cal profile of dengue hemorrhagic fever cases in Mexico. Salud
Publica de Mexico 2005; 47:193-200.
Published
2007-02-28
How to Cite
1.
Junia J, Garna H, Setiabudi D. Clinical risk factors for dengue shock syndrome in children. PI [Internet]. 28Feb.2007 [cited 25Apr.2024];47(1):7-1. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/257
Section
Articles
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Received 2016-08-19
Accepted 2016-08-19
Published 2007-02-28
Accepted 2016-08-19
Published 2007-02-28
