The predictive diagnostic value of serial daily bedside ultrasonography for severe dengue in Indonesian adults.
BACKGROUND: Identification of dengue patients at risk for progressing to severe disease is difficult. Significant plasma leakage is a hallmark of severe dengue infection which can suddenly lead to hypovolemic shock around the time of defervescence. We hypothesized that the detection of subclinical p...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2013-01-01
|
| Series: | PLoS Neglected Tropical Diseases |
| Online Access: | http://europepmc.org/articles/PMC3681666?pdf=render |
| _version_ | 1818947833225543680 |
|---|---|
| author | Meta Michels Uun Sumardi Quirijn de Mast Hadi Jusuf Mita Puspita Intan Mauli Warma Dewi Sylvia Sinarta Bachti Alisjahbana André J A M van der Ven |
| author_facet | Meta Michels Uun Sumardi Quirijn de Mast Hadi Jusuf Mita Puspita Intan Mauli Warma Dewi Sylvia Sinarta Bachti Alisjahbana André J A M van der Ven |
| author_sort | Meta Michels |
| collection | DOAJ |
| description | BACKGROUND: Identification of dengue patients at risk for progressing to severe disease is difficult. Significant plasma leakage is a hallmark of severe dengue infection which can suddenly lead to hypovolemic shock around the time of defervescence. We hypothesized that the detection of subclinical plasma leakage may identify those at risk for severe dengue. The aim of the study was to determine the predictive diagnostic value of serial ultrasonography for severe dengue. METHODOLOGY/PRINCIPAL FINDINGS: Daily bedside ultrasounds were performed with a handheld ultrasound device in a prospective cohort of adult Indonesians with dengue. Timing, localization and relation to dengue severity of the ultrasonography findings were determined, as well as the relation with serial hematocrit and albumin values. The severity of dengue was retrospectively determined by WHO 2009 criteria. A total of 66 patients with proven dengue infection were included in the study of whom 11 developed severe dengue. Presence of subclinical plasma leakage at enrollment had a positive predictive value of 35% and a negative predictive value of 90% for severe dengue. At enrollment, 55% of severe dengue cases already had subclinical plasma leakage, which increased to 91% during the subsequent days. Gallbladder wall edema was more pronounced in severe than in non-severe dengue patients and often preceded ascites/pleural effusion. Serial hematocrit and albumin measurements failed to identify plasma leakage and patients at risk for severe dengue. CONCLUSIONS/SIGNIFICANCE: Serial ultrasonography, in contrast to existing markers such as hematocrit, may better identify patients at risk for development of severe dengue. Patients with evidence of subclinical plasma leakage and/or an edematous gallbladder wall by ultrasonography merit intensive monitoring for development of complications. |
| first_indexed | 2024-12-20T08:37:11Z |
| format | Article |
| id | doaj.art-4ff64bf5ee4d49bbb24ddf1e3dce9b44 |
| institution | Directory Open Access Journal |
| issn | 1935-2727 1935-2735 |
| language | English |
| last_indexed | 2024-12-20T08:37:11Z |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Neglected Tropical Diseases |
| spelling | doaj.art-4ff64bf5ee4d49bbb24ddf1e3dce9b442022-12-21T19:46:31ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352013-01-0176e227710.1371/journal.pntd.0002277The predictive diagnostic value of serial daily bedside ultrasonography for severe dengue in Indonesian adults.Meta MichelsUun SumardiQuirijn de MastHadi JusufMita PuspitaIntan Mauli Warma DewiSylvia SinartaBachti AlisjahbanaAndré J A M van der VenBACKGROUND: Identification of dengue patients at risk for progressing to severe disease is difficult. Significant plasma leakage is a hallmark of severe dengue infection which can suddenly lead to hypovolemic shock around the time of defervescence. We hypothesized that the detection of subclinical plasma leakage may identify those at risk for severe dengue. The aim of the study was to determine the predictive diagnostic value of serial ultrasonography for severe dengue. METHODOLOGY/PRINCIPAL FINDINGS: Daily bedside ultrasounds were performed with a handheld ultrasound device in a prospective cohort of adult Indonesians with dengue. Timing, localization and relation to dengue severity of the ultrasonography findings were determined, as well as the relation with serial hematocrit and albumin values. The severity of dengue was retrospectively determined by WHO 2009 criteria. A total of 66 patients with proven dengue infection were included in the study of whom 11 developed severe dengue. Presence of subclinical plasma leakage at enrollment had a positive predictive value of 35% and a negative predictive value of 90% for severe dengue. At enrollment, 55% of severe dengue cases already had subclinical plasma leakage, which increased to 91% during the subsequent days. Gallbladder wall edema was more pronounced in severe than in non-severe dengue patients and often preceded ascites/pleural effusion. Serial hematocrit and albumin measurements failed to identify plasma leakage and patients at risk for severe dengue. CONCLUSIONS/SIGNIFICANCE: Serial ultrasonography, in contrast to existing markers such as hematocrit, may better identify patients at risk for development of severe dengue. Patients with evidence of subclinical plasma leakage and/or an edematous gallbladder wall by ultrasonography merit intensive monitoring for development of complications.http://europepmc.org/articles/PMC3681666?pdf=render |
| spellingShingle | Meta Michels Uun Sumardi Quirijn de Mast Hadi Jusuf Mita Puspita Intan Mauli Warma Dewi Sylvia Sinarta Bachti Alisjahbana André J A M van der Ven The predictive diagnostic value of serial daily bedside ultrasonography for severe dengue in Indonesian adults. PLoS Neglected Tropical Diseases |
| title | The predictive diagnostic value of serial daily bedside ultrasonography for severe dengue in Indonesian adults. |
| title_full | The predictive diagnostic value of serial daily bedside ultrasonography for severe dengue in Indonesian adults. |
| title_fullStr | The predictive diagnostic value of serial daily bedside ultrasonography for severe dengue in Indonesian adults. |
| title_full_unstemmed | The predictive diagnostic value of serial daily bedside ultrasonography for severe dengue in Indonesian adults. |
| title_short | The predictive diagnostic value of serial daily bedside ultrasonography for severe dengue in Indonesian adults. |
| title_sort | predictive diagnostic value of serial daily bedside ultrasonography for severe dengue in indonesian adults |
| url | http://europepmc.org/articles/PMC3681666?pdf=render |
| work_keys_str_mv | AT metamichels thepredictivediagnosticvalueofserialdailybedsideultrasonographyforseveredengueinindonesianadults AT uunsumardi thepredictivediagnosticvalueofserialdailybedsideultrasonographyforseveredengueinindonesianadults AT quirijndemast thepredictivediagnosticvalueofserialdailybedsideultrasonographyforseveredengueinindonesianadults AT hadijusuf thepredictivediagnosticvalueofserialdailybedsideultrasonographyforseveredengueinindonesianadults AT mitapuspita thepredictivediagnosticvalueofserialdailybedsideultrasonographyforseveredengueinindonesianadults AT intanmauliwarmadewi thepredictivediagnosticvalueofserialdailybedsideultrasonographyforseveredengueinindonesianadults AT sylviasinarta thepredictivediagnosticvalueofserialdailybedsideultrasonographyforseveredengueinindonesianadults AT bachtialisjahbana thepredictivediagnosticvalueofserialdailybedsideultrasonographyforseveredengueinindonesianadults AT andrejamvanderven thepredictivediagnosticvalueofserialdailybedsideultrasonographyforseveredengueinindonesianadults AT metamichels predictivediagnosticvalueofserialdailybedsideultrasonographyforseveredengueinindonesianadults AT uunsumardi predictivediagnosticvalueofserialdailybedsideultrasonographyforseveredengueinindonesianadults AT quirijndemast predictivediagnosticvalueofserialdailybedsideultrasonographyforseveredengueinindonesianadults AT hadijusuf predictivediagnosticvalueofserialdailybedsideultrasonographyforseveredengueinindonesianadults AT mitapuspita predictivediagnosticvalueofserialdailybedsideultrasonographyforseveredengueinindonesianadults AT intanmauliwarmadewi predictivediagnosticvalueofserialdailybedsideultrasonographyforseveredengueinindonesianadults AT sylviasinarta predictivediagnosticvalueofserialdailybedsideultrasonographyforseveredengueinindonesianadults AT bachtialisjahbana predictivediagnosticvalueofserialdailybedsideultrasonographyforseveredengueinindonesianadults AT andrejamvanderven predictivediagnosticvalueofserialdailybedsideultrasonographyforseveredengueinindonesianadults |