Publication:

A study of morbidity and mortality markers in children diagnosed with severe dengue illness at a quaternary paediatric intensive care unit

Background To identify the biochemical, haematological, and serological laboratory parameters and establish associations between mortality risk and children with severe dengue fever (DF).

Methods This retro-prospective study included 251 children who were dengue serology positive, aged between 1 month and 18 years, hospitalized in paediatric intensive care unit (PICU) with severe dengue illness from July 2019 to June 2021. Clinical, laboratory, and radiological data were extracted from hospital's electronic database and analyzed.

Results The majority had a mean age of 5.46 years with a significant female predominance (58.2%). Also, 80.1 per cent of children presented in the critical phase with an average PICU stay of 3.59 days. There was a significant mortality risk associated with presenting day of illness (risk 9.5%), ventilation requirements (risk 29.8%), and stay of more than a week in the PICU (risk 36%), with that of the severity of outcomes. The odds of increased mortality risk were associated with prolonged PICU stay exceeding a week and ventilation requirements by 10.03 and 20.19 times respectively. Investigation-wise, abnormal liver enzymes on admission such as SGOT (OR 5.39, p>0.0001); and serum SGPT (OR 5.54, p<0.001) were significantly associated with poorer outcomes. Interestingly, neither thrombocytopenia nor leucopenia was found to be a true marker of mortality and the overall mortality rate was found to be 8.4% (n=21).

Conclusions Any stay of more than a week, abnormal liver enzymes on admission, and ventilation requirements were all associated with higher mortality risk and potential predictors for poor clinical outcomes in the PICU.