Predictive Correlation of Adverse Clinical Outcomes With Thrombocytopenia in Dengue Fever: A Single Center Experience

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Background: Dengue fever is the most widely distributed viral infection in the world with more than 100 million people affected. In this study we attempt to study the co-relation between the nadir of the platelet count and the onset of warning signs (persistent pain abdomen and vomiting, mucocutaneous bleed or clinical uid accumulations). A positive co-relation in between these two elements could help predict onset of shock and third spacing and facilitate prognostication and early intervention. Methods: We studied 82 patients with a diagnosis of dengue fever, the basis of which was clinical signs and symptoms with a positive NS1 antigen test. The nadir of thrombocytopenia and rise in transaminases were studied along with onset of various warning signs. Results:The nadir of thrombocytopenia correlates with onset of warning signs such as clinical uid accumulation (two tailed P value <0.002) and mucosal bleed (two tailed P value <0.001). However, the rising value of transaminases does not co-relate statistically with onset of warning signs in Dengue fever. Conclusions: The age of patients ranged from 18 to 60 with 23 out of 83 (27.7%) being in the 30-40 years age group. Clinical uid accumulation was seen in 54 (64.7%) patients, mucosal bleed in 61 patients (74.3%) and liver was palpable more than 2 cm in 28 patients (33.7%). The importance of serial monitoring of platelets is important not only for the prediction of severe dengue, but also with the onset of other warning signs such as clinical uid accumulation. This nuanced fact re-enforces the critical importance of platelet count predict other warning signs which contribute to morbidity and mortality in dengue fever.