PREDICTORS FOR SEVERE DENGUE IN ADULTS: A SYSTEMATIC REVIEW
Abstract
Introduction: Dengue infection inflicted a huge burden towards health problem in tropical and subtropical countries. Reported cases were more than 1.2 million in 2008, which increased to over 3.2 million in 2015, involving the Americas, South-East Asia, and Western Pacific regions. Published studies regarding predictors of severe dengue have been inconsistent and therefore accurate methods to predict severe dengue is needed. This review was performed to synthesise from the relevant studies regarding predictors of severe dengue.
Methodology: A systematic literature search was performed using PubMed, ScienceDirect, and Google Scholar for articles published from 2015 until 2019. The search was based on the inclusion criteria and keywords, including 'predictors', 'factors associated’, 'severe dengue' and 'dengue haemorrhagic fever' and 'dengue shock syndrome'. The inclusion criteria were all observational studies with full articles and written in English. Reviewed articles, systematic review and meta-analysis articles were excluded. Study on children and solely involved biomolecular components were also excluded. Unpublished literature was not searched in this review.
Result: After multistage screening conducted based on inclusion and exclusion criteria, 9 out of 1312 initially searched articles, were assessed and reviewed in the final stage. The significant predictors were reported to increase risk of severe dengue significantly includes sociodemographic (age), medical history (secondary infection, pre-existing comorbid), clinical presentation (warning signs, fluid accumulation, bleeding tendency, low blood pressure), laboratory profile (increase haematocrit, low platelet count, raised ALT, raised lactate), secondary dengue infection and as well as the delayed hospitalisation and late seeking treatment.
Conclusion: In conclusion, older age group, presence of comorbid and the number of comorbid, secondary infections, presence of warning signs, abnormal haematocrit rise and platelet count drop, were independent risk factors of severe dengue. These factors may be useful to guide triage at the presentation of adult dengue patients who are at higher risk of severe dengue.
Keyword: predictors, severe dengue, dengue haemorrhagic fever, dengue shock syndrome, systematic review