Jain et al reported a simple score for predicting mortality in a patient with dengue. The authors are from the All India Institute of Medical Sciences and the National Institute of Virology of India.
Patient selection: dengue fever
Parameters from multivariate analysis:
(1) sensorium
(2) age in years
(3) dyspnea at rest
Parameters
Findings
Points
sensorium
normal
0
altered
14
age in years
< 24 years
0
>= 24 years
12
dyspnea at rest
no
0
yes
10
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 36
• A score >= 22 was predictive of mortality, with a sensitivity of 0.82 and specificity of 0.79. This is equivalent to 2 or 3 of the parameters.
• All patients who died had dengue shock syndrome (DSS).
• Timely referral of the patient can improve outcomes (late presentation if >= 5 days).
Additional factors from univariate analysis (reflecting dengue shock syndrome):
(1) hepatic dysfunction (with elevated AST and ALT)
(2) renal dysfunction
(3) ARDS
(4) DIC
(5) metabolic acidosis
(6) vasopressor use
Performance of score:
• The area under ROC curve was 0.85.
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