Asociación entre la magnitud del viraje del hematocrito y otros indicadores de severidad en dengue

Abstract

Objectives: To determine the association of hemoconcentration with other signs of severity of dengue. Design: Cross sectional study. Population and methods: Patients with clinical and serologic diagnosis (IgM positive test) of dengue, who consulted hospitals in Santander (Colombia), during 1993-1998. The clinical findings and laboratory tests were registered. Associations among hemoconcentration and complications, such as spontaneous hemorrhages (petechiae, ecchymoses, bleeding from gums, epistaxis, hematemesis, hematuria and metrorrhagia), pleural effusions and thrombocytopenia (<50,000 plt/μ l), were evaluated. Results: A sampling of 780 patients was included. In a multi-varied analysis, thrombocytopenia (p <0.001), hematemesis (p=0.04), and age under 15 years (p=0.02) were associated to greater hemoconcentration. There were 363 patients with hemoconcentration <10%; 226 with 10%-20%; and 191 with >20%. There were no significant differences in frequency of pleural effusions within these groups. Hematemesis and thrombocytopenia were less frequent in patients with hemoconcentration <10% compared with both, 10%-20% and >20% groups. Moreover, patients with hemoconcentration >20% had more complications than the group with hemoconcentration of 10%-20% (p<0.05). Compared with>20%, a hematocrit change >10% was associated to increasing sensitivity from 31% to 63.4% and diminishing of specificity from 88.5% to 66.3%, to detect some complications (hematemesis, thrombocytopenia, or pleural effusion). Conclusions: This study suggests a strong correlation between hemoconcentration and severity of dengue. Also, more liberal criteria to define plasma leakage could be used. The present results should be prospectively evaluated in cohort studies. © 2009 Universidad del Valle, Facultad de Salud.