Shock Prognostic Factors in Hospitalized Dengue Hemorrhagic Fever Children

Various clinical manifestations, complex pathogenesis and different virus serotypes in diverse area make us difficult to predict course of disease, even the child admitted in early. Prognostic factors are very important to predict cases progressing to become DSS. Dengue shock syndrome (DSS) occurs in 15.53% of Dengue hemorrhagic fever (DHF) patients with 7.81% mortality rate. Aim: To explore the prognostic factors of shock in hospitalized DHF children regarding the new 2011 WHO dengue virus infection classification guideline. This was a retrospective study using medical records of children age below 18 years old with WHO fulfilled grade 1 and 2 DHF diagnosis from January 2013–December 2016 in Child Health Department of Dr. Cipto Mangunkusumo Hospital, Jakarta. Independent variables were sex, age, nutritional status, secondary dengue infection, leucopenia, abdominal tenderness, gastrointestinal bleeding, hepatomegaly and plasma leakage. Shock was dependent variable. Multivariate analysis was done by using logistic regresion analysis. There were 98 DHF subjects, 5 subjects became DSS during hospitalization. DSS subject characteristics were age of >5 years old, female, malnutrition, abdominal tenderness, hemoconcentration ≥20%, secondary dengue infection, leucocyte ≥5.000 mm³ and thrombocyte <50.000 mm³. Multivaryate analysis showed malnutrition and hepatomegaly were prognosis factors of DSS. Malnutrition and hepatomegaly were prognotic factors of dengue shock syndrome. Clinicians should be more aware with these factors when managed hospitalized DHF patients.