Philippine E-Journals

Profile and risk factors for mortality and bleeding amongst dengue shock syndrome patients admitted at PCMC January 2003-2005

Melissa S. Carcabuso | Jheanance Ang | Benjamin T. Lim

Discipline: medicine by specialism

 

Abstract:

Objective: To determine the clinical features and risk factors of bleeding and mortality amongst Dengue Hemorrhagic Fever Grade III and IV patients admitted at Philippine Children’s Medical Center from January 2003- December 2005. Design: Retrospective Study Setting: Tertiary Medical Center Patients/Participants: Charts of patient's aged 0-19 y/o of both genders with a final diagnosis of dengue shock syndrome from January 2003 to December 2005 were included in the study. Method: Charts of patient's aged 0-19 y/o of both genders with a final diagnosis of dengue shock syndrome from January 2003 to December 2005 were included in the study. Their vital signs (BP, CR, RR, temperature), weight, level of consciousness, character of pulse, capillary refill time, occurrence of shock on day of illness of the occurrence of shock and laboratories on admission such as hematocrit, platelet, albumin, PT, and PTT were noted. These factors were analyzed using the univariate analysis and binary logistic regression. Results: There are a total of 345 charts of patients reviewed from January 2003-2005. Among the patients, 177 (51.3%) were male and 168 (48.7%) were female. Majority of patients who had dengue shock syndrome belonged to the 6-9y/o0 (39.1 %). Shock developed in a range of day 3-9 of illness. 38.3% of the patients developed shock in the 5" day of illness. Of the patients reviewed there was a 5.8% mortality rate with majority belonging in the 2-5 and 6-9 y/o age group with a 3.5 average hospital stay. Majority of the patients died because Disseminated Intravascular Coagulopathy followed by Multiple Organ Dysfunction Syndrome. One patient died of Acute Respiratory Distress Syndrome. Among the patients who died, 45% developed shock on the 5% day of illness, 60% had normal weigh, 65% were drowsy, 90% had tachycardia, 50% had normal effort of breathing, 80% had prolonged capillary refill time. 50% had normal hematocrit, 45% had hemoconcentration, 50% had prolonged PT, 85% had prolonged PTT, 85% had low albumin. Blood type B and O occurred equally at 35%.25% of the patients who died had bleeding. Hematocrit, PT, and PTT had no association with bleeding. On univariate analysis, level of consciousness, bleeding, CRT, platelet, PT, PTT, and albumin had an association with mortality. However no association was noted on logistic regression. Conclusion: In this study, level of consciousness, bleeding, CRT, platelet, PT, PTT, and albumin had an association with mortality on univariate analysis. However, upon logistic regression none of the factors showed association with mortality.