dc.contributor.authorPang, Junxiong
dc.contributor.authorThein, Tun-Linn
dc.contributor.authorLeo, Yee-Sin
dc.contributor.authorLye, David C
dc.date.accessioned2015-03-24T07:08:05Z
dc.date.available2015-03-24T07:08:05Z
dc.date.copyright2014en_US
dc.date.issued2014
dc.identifier.citationPang, J., Thein, T.-L., Leo, Y.-S., & Lye, D. C. (2014). Early clinical and laboratory risk factors of intensive care unit requirement during 2004-2008 dengue epidemics in Singapore : a matched case-control study. BMC infectious diseases, 14,649-.en_US
dc.identifier.issn1471-2334en_US
dc.identifier.urihttp://hdl.handle.net/10220/25265
dc.description.abstractBackground: Dengue infection can result in severe clinical manifestations requiring intensive care. Effective triage is critical for early clinical management to reduce morbidity and mortality. However, there is limited knowledge on early risk factors of intensive care unit (ICU) requirement. This study aims to identify early clinical and laboratory risk factors of ICU requirement at first presentation in hospital and 24 hours prior to ICU requirement. Method: A retrospective 1:4 matched case–control study was performed with 27 dengue patients who required ICU, and 108 dengue patients who did not require ICU from year 2004–2008, matched by year of dengue presentation. Univariate and multivariate conditional logistic regression were performed. Optimal predictive models were generated with statistically significant risk factors identified using stepwise forward and backward elimination method. Results: ICU dengue patients were significantly older (P=0.003) and had diabetes (P=0.031), compared with non-ICU dengue patients. There were seven deaths among ICU patients at median seven days post fever. At first presentation, the WHO 2009 classification of dengue severity was significantly associated (P<0.001) with ICU, but not the WHO 1997 classification. Early clinical risk factors at presentation associated with ICU requirement were hematocrit change ≥20% concurrent with platelet <50 K [95% confidence-interval (CI)=2.46-30.53], hypoproteinemia (95% CI=1.09-19.74), hypotension (95% CI=1.83-31.79) and severe organ involvement (95% CI=3.30-331). Early laboratory risk factors at presentation were neutrophil proportion (95% CI=1.04-1.17), serum urea (95% CI=1.02-1.56) and alanine aminotransferase level (95% CI=1.001-1.06). This predictive model has sensitivity and specificity up to 88%. Early laboratory risk factors at 24 hours prior to ICU were lymphocyte (95% CI=1.03-1.38) and monocyte proportions (95% CI=1.02-1.78), pulse rate (95% CI=1.002-1.14) and blood pressure (95% CI=0.92-0.996). This predictive model has sensitivity and specificity up to 88.9% and 78%, respectively. Conclusions: This is the first matched case–control study, to our best knowledge, that identified early clinical and laboratory risk factors of ICU requirement during hospitalization. These factors suggested differential pathophysiological background of dengue patients as early as first presentation prior to ICU requirement, which may reflect the pathogenesis of dengue severity. These risk models may facilitate clinicians in triage of patients, after validating in larger independent studies.en_US
dc.format.extent11 p.en_US
dc.language.isoenen_US
dc.relation.ispartofseriesBMC infectious diseasesen_US
dc.rights© 2014 Pang et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.en_US
dc.subjectDRNTU::Science::Biological sciences::Microbiology::Bacteria
dc.titleEarly clinical and laboratory risk factors of intensive care unit requirement during 2004-2008 dengue epidemics in Singapore : a matched case-control studyen_US
dc.typeJournal Article
dc.contributor.schoolLee Kong Chian School of Medicine
dc.identifier.doihttp://dx.doi.org/10.1186/s12879-014-0649-2
dc.description.versionPublished versionen_US


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record