Predicting severity in dengue patients - How far have we reached?

ABSTRACT Background: Dengue fever (DF) is a viral infection endemic in more than 100 countries in the tropical and subtropical regions of the world, especially tropical Asia including India, Central and South America, and the Caribbean. Dengue evolves with a dynamic course. There is limited knowledge about the predictive biomarkers to assess the severity progression of the disease. Aim: To study the clinical, hematological, and biochemical changes at the time of presentation in dengue patients and analyze their utility in discriminating patients with dengue fever from those with dengue hemorrhagic fever, with a brief review of the literature. Methods: This study was a cross-sectional study conducted in the department of medicine and the department of pathology of a tertiary care hospital in New Delhi. The study included 101 patients with clinical and serological diagnosis of dengue fever over a period of one month. The patients were allocated into two groups: Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF), and their clinical features, hematological profile, and biochemical parameters serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were recorded and analyzed. Results: Leucopenia with activated lymphocytes, thrombocytopenia, and increased hematocrit were the most common hematological changes observed in the dengue patients. Liver enzymes (AST and ALT) were altered in both DF and DHF with more derangement being noted in DHF. Conclusion: Patients with both dengue fever and dengue hemorrhagic fever presented with similar clinical, hematological, and biochemical changes; however, these changes were more pronounced in the latter. Hence, the laboratory parameters can be used as an adjunct to early diagnosis and also in predicting the severity of dengue.