Seng, Liu Yeo
(2017)
Clinical manifestation and laboratory findings as predictive factors for dengue mortality in Kota Bharu.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background: Dengue fever is an endemic disease in Malaysia. Changing of time made
the classical clinical manifestation of dengue fever become vary and present a challenge
in diagnosing and managing the patients. Warning signs and laboratory changes as
describes in the WHO dengue guidelines 2009 are not usually present in every patient.
We aim to identify the clinical manifestation and laboratory findings among the
confirmed adults dengue-associated mortality patients in Kota Bharu Kelantan
Malaysia.
Methods: We conducted a case control study in all confirmed dengue death patients in
Kota Bharu from January of 2005 till December 2015. All adult death patients were
included and control was by computer-generated randomization. Four controls were
chosen for every dengue-associated death case. Data were analysed by simple and
multiple logistic regression.
Results: Of 25 deaths, median age was 42 (SD ±14.5) years old. Male gender
comprised of 56% and comorbidities existed in 60% of the cases. Majority of patients
sought treatment at the average of day 5 of fever. The warning sign that most patients
had were nausea/ vomiting while the least was mucosal bleed. Laboratory abnormalities
on admission included leucopenia (40%), leucocytosis (16%), raised urea (28%) and
creatinine (36%). 80% of the dengue-associated mortality had thrombocytopenia during
presentation with mean of 74.2 x 103(SD ±62.61). Multiple logistic regression analysis
showed two clinical manifestations were negatively associated with dengue-associated
mortality – vomiting/nausea (adj. OR 0.13, 95% CI 0.02-0.76) and headache (adj.OR0.15, 95% CI 0.03-0.86). Laboratory findings that were associated with dengueassociated
mortality were first TWC (adj. OR 1.82, 95% CI 1.08-3.05), second TWC
(adj. OR 1.54, 95% CI 1.15-2.07), second platelet (adj. OR 0.97, 95% CI 0.95-0.99),
urea (adj. OR 2.35, 95% CI 1.43-3.85) and creatinine (adj. OR 0.98, 95% CI 0.97-1.00).
Conclusions: Dengue patients with vomiting/nausea and headache were the clinical
manifestations of lower chance of having dengue-associated mortality. Laboratory
findings of increasing in total white count and urea, reducing in platelet and creatinine
were more likely to associate with dengue-associated mortality. Early detection of
clinical deterioration and prompt treatment is the main key of prevention of death.
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