John et al reported risk factors for bleeding and for mortality in a patent with dengue fever. These can help to identify a patient who may require more aggressive management. The authors are from Christian Medical College in Vellore, India.
Patient selection: dengue fever
Dengue cases were classified by the 2009 WHO criteria:
(1) dengue without warning signs
(2) dengue with warning signs
(3) severe dengue
Primary dengue: IgM antibody positive OR NSI antigen positive
Secondary dengue: IgG antibody positive, with or without IgM
Risk factors for bleeding (from Table 3):
(1) elevated AST (> 600 IU/L) and ALT (> 400 IU/L)
(2) severe dengue
(3) secondary dengue
Risk factors for mortality (from Table 4):
(1) older age (> 40 years)
(2) elevated WBC count (>= 10,000 per µL)
(3) elevated serum total bilirubin (> 35 µmol/L)
(4) elevated serum creatinine (> 100 µmol/L)
(5) elevated AST (> 1,000 IU/L) and ALT (> 500 IU/L)
(6) high SOFA score (>= 5)
