The coagulation profile of children admitted with dengue fever and correlation with clinical severity

Abstract

Background: Dengue is one of the 17 Neglected Tropical diseases (NTD) addressed in the NTD road map. Objective of present study was to find out the correlation between coagulation profile abnormalities and clinical severity of dengue fever.Methods: All cases of dengue fever in children below 12 years of age admitted to a tertiary care medical college of South India for a period of 18 months (January 2013- June 2014) were included in the study. The liver function tests, prothrombin time, International normalises ratio and activated partial thromboplastin level were estimated and correlated with severity.Results: Of the 306 cases of children admitted with dengue fever, 131 (42.8%) were dengue fever without warning signs, 119 (38.8%) were dengue fever with warning signs and 56 (18.4%) were severe dengue according to WHO guidelines 2012. 20.9% cases had significant PT prolongation, 50.3% had INR >1.1 and 33.3% had aPTT prolongation. Of the 56 cases of severe dengue, 83.9% had PT prolongation, 96.4% had INR >1.1 and 91.1% had significant aPTT prolongation. The mean values of PT, INR and aPTT in severe dengue was 19±3.7sec, 1.5±0.3 and 46±7 sec respectively. These were well above the cut off values and showed statistically significant association with severe dengue (p<0.001) compared to non-severe dengue. Similarly, ALT elevation among the total cases also showed majority (67.3%) in the range of 40-400. Of the 56 cases of severe dengue, 30% had values above 1000 IU/l, 51% had AST levels 40-400, and 16% had 400-1000 and 2.5% below 40. Statistical analysis showed significant difference in AST and ALT elevation among dengue fever without warning signs, dengue fever with warning signs and severe dengue (p<0.001).Conclusions: There is statistically significant association between prolongation of coagulation markers and severity of dengue.