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Utilities and Limitations of the World Health Organization 2009 Warning Signs for Adult Dengue Severity

BACKGROUND: In 2009, the World Health Organization (WHO) proposed seven warning signs (WS) as criteria for hospitalization and predictors of severe dengue (SD). We assessed their performance for predicting dengue hemorrhagic fever (DHF) and SD in adult dengue. METHOD: DHF, WS and SD were defined acc...

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Autores principales: Thein, Tun-Linn, Gan, Victor C., Lye, David C., Yung, Chee-Fu, Leo, Yee-Sin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3547865/
https://www.ncbi.nlm.nih.gov/pubmed/23350013
http://dx.doi.org/10.1371/journal.pntd.0002023
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author Thein, Tun-Linn
Gan, Victor C.
Lye, David C.
Yung, Chee-Fu
Leo, Yee-Sin
author_facet Thein, Tun-Linn
Gan, Victor C.
Lye, David C.
Yung, Chee-Fu
Leo, Yee-Sin
author_sort Thein, Tun-Linn
collection PubMed
description BACKGROUND: In 2009, the World Health Organization (WHO) proposed seven warning signs (WS) as criteria for hospitalization and predictors of severe dengue (SD). We assessed their performance for predicting dengue hemorrhagic fever (DHF) and SD in adult dengue. METHOD: DHF, WS and SD were defined according to the WHO 1997 and 2009 dengue guidelines. We analyzed the prevalence, sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of WS before DHF and SD onset. RESULTS: Of 1507 cases, median age was 35 years (5(th)–95(th) percentile, 17–60), illness duration on admission 4 days (5(th)–95(th) percentile, 2–6) and length of hospitalization 5 days (5(th)–95(th) percentile, 3–7). DHF occurred in 298 (19.5%) and SD in 248 (16.5%). Of these, WS occurred before DHF in 124 and SD in 65 at median of two days before DHF or SD. Three commonest warning signs were lethargy, abdominal pain/tenderness and mucosal bleeding. No single WS alone or combined had Sn >64% in predicting severe disease. Specificity was >90% for both DHF and SD with persistent vomiting, hepatomegaly, hematocrit rise and rapid platelet drop, clinical fluid accumulation, and any 3 or 4 WS. Any one of seven WS had 96% Sn but only 18% Sp for SD. CONCLUSIONS: No WS was highly sensitive in predicting subsequent DHF or SD in our confirmed adult dengue cohort. Persistent vomiting, hepatomegaly, hematocrit rise and rapid platelet drop, and clinical fluid accumulation, as well as any 3 or 4 WS were highly specific for DHF or SD.
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spelling pubmed-35478652013-01-24 Utilities and Limitations of the World Health Organization 2009 Warning Signs for Adult Dengue Severity Thein, Tun-Linn Gan, Victor C. Lye, David C. Yung, Chee-Fu Leo, Yee-Sin PLoS Negl Trop Dis Research Article BACKGROUND: In 2009, the World Health Organization (WHO) proposed seven warning signs (WS) as criteria for hospitalization and predictors of severe dengue (SD). We assessed their performance for predicting dengue hemorrhagic fever (DHF) and SD in adult dengue. METHOD: DHF, WS and SD were defined according to the WHO 1997 and 2009 dengue guidelines. We analyzed the prevalence, sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of WS before DHF and SD onset. RESULTS: Of 1507 cases, median age was 35 years (5(th)–95(th) percentile, 17–60), illness duration on admission 4 days (5(th)–95(th) percentile, 2–6) and length of hospitalization 5 days (5(th)–95(th) percentile, 3–7). DHF occurred in 298 (19.5%) and SD in 248 (16.5%). Of these, WS occurred before DHF in 124 and SD in 65 at median of two days before DHF or SD. Three commonest warning signs were lethargy, abdominal pain/tenderness and mucosal bleeding. No single WS alone or combined had Sn >64% in predicting severe disease. Specificity was >90% for both DHF and SD with persistent vomiting, hepatomegaly, hematocrit rise and rapid platelet drop, clinical fluid accumulation, and any 3 or 4 WS. Any one of seven WS had 96% Sn but only 18% Sp for SD. CONCLUSIONS: No WS was highly sensitive in predicting subsequent DHF or SD in our confirmed adult dengue cohort. Persistent vomiting, hepatomegaly, hematocrit rise and rapid platelet drop, and clinical fluid accumulation, as well as any 3 or 4 WS were highly specific for DHF or SD. Public Library of Science 2013-01-17 /pmc/articles/PMC3547865/ /pubmed/23350013 http://dx.doi.org/10.1371/journal.pntd.0002023 Text en © 2013 Thein et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Thein, Tun-Linn
Gan, Victor C.
Lye, David C.
Yung, Chee-Fu
Leo, Yee-Sin
Utilities and Limitations of the World Health Organization 2009 Warning Signs for Adult Dengue Severity
title Utilities and Limitations of the World Health Organization 2009 Warning Signs for Adult Dengue Severity
title_full Utilities and Limitations of the World Health Organization 2009 Warning Signs for Adult Dengue Severity
title_fullStr Utilities and Limitations of the World Health Organization 2009 Warning Signs for Adult Dengue Severity
title_full_unstemmed Utilities and Limitations of the World Health Organization 2009 Warning Signs for Adult Dengue Severity
title_short Utilities and Limitations of the World Health Organization 2009 Warning Signs for Adult Dengue Severity
title_sort utilities and limitations of the world health organization 2009 warning signs for adult dengue severity
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3547865/
https://www.ncbi.nlm.nih.gov/pubmed/23350013
http://dx.doi.org/10.1371/journal.pntd.0002023
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