Contributions
Abstract: PB1596
Type: Publication Only
Session title: Infections in hematology (incl. supportive care/therapy)
Background
Dengue fever is a viral infection caused by four distinct serotypes of the dengue virus, transmitted to humans by female mosquitos of Aedes species. It is the most critical mosquito-borne disease globally. Infection leads to clinical manifestations ranging from undifferentiated fever to dengue haemorrhagic fever (DHF) and dengue shock syndrome. DHF has three stages namely febrile phase, critical phase and convalescent phase. Plasma leakage and abnormal haemostasis are the two key characteristic pathophysiological features of DHF. Identifying patients likely to progress to the critical phase, as soon as possible, would be a major advantage in initiating management early.
Aims
Several factors associated with progression to critical phase have been described. The usefulness of ROTEM in predicting which patient will go to critical phase has not been hitherto reported. The main objective of this study was to assess if conventional coagulation tests (CCT) and ROTEM parameters are useful predictors of progression to critical phase in patients in febrile phase of dengue fever.
Methods
A prospective case control study was performed in medical units at National Hospital of Sri Lanka on patients with fever and a positive dengue NS1 antigen test. CCT (PT, APTT & Clauss fibrinogen assay) and ROTEM (EXTEM & INTEM) were performed in patients in febrile phase, on 3rd day of fever, if the platelet count > 100 x 109/L and no features of plasma leakage. Patients enrolled were followed up and if they progressed into critical phase were categorized as “cases” and if they did not (recovered from the febrile phase) categorized as “controls”.
Results
A prospective case control study was performed in medical units at National Hospital of Sri Lanka on patients with fever and a positive dengue NS1 antigen test. CCT (PT, APTT & Clauss fibrinogen assay) and ROTEM (EXTEM & INTEM) were performed in patients in febrile phase, on 3rd day of fever, if the platelet count > 100 x 109/L and no features of plasma leakage. Patients enrolled were followed up and if they progressed into critical phase were categorized as “cases” and if they did not (recovered from the febrile phase) categorized as “controls”.
Conclusion
Conventional coagulation tests were not useful in predicting progression to the critical phase. ROTEM parameters CT & CFT of EXTEM and CFT of INTEM, which can be ascertained at point of care, even in an outpatient setting, in about 10-15 minutes, appeared to be useful in predicting which patient is likely to progress to the critical phase from the febrile phase of dengue fever. When combined, specific cut-off values for each of these 3 parameters gave a NPV of >80% in patients in the febrile phase of dengue fever, on the 3rd day of fever. This preliminary study suggests that a larger study looking at ROTEM parameters, not only on the 3rd day, but also on 4th and 5th days of fever may be useful in predicting which patient with dengue fever is likely to progress to the critical phase.
Keyword(s): Coagulation, Thrombelastograph
Abstract: PB1596
Type: Publication Only
Session title: Infections in hematology (incl. supportive care/therapy)
Background
Dengue fever is a viral infection caused by four distinct serotypes of the dengue virus, transmitted to humans by female mosquitos of Aedes species. It is the most critical mosquito-borne disease globally. Infection leads to clinical manifestations ranging from undifferentiated fever to dengue haemorrhagic fever (DHF) and dengue shock syndrome. DHF has three stages namely febrile phase, critical phase and convalescent phase. Plasma leakage and abnormal haemostasis are the two key characteristic pathophysiological features of DHF. Identifying patients likely to progress to the critical phase, as soon as possible, would be a major advantage in initiating management early.
Aims
Several factors associated with progression to critical phase have been described. The usefulness of ROTEM in predicting which patient will go to critical phase has not been hitherto reported. The main objective of this study was to assess if conventional coagulation tests (CCT) and ROTEM parameters are useful predictors of progression to critical phase in patients in febrile phase of dengue fever.
Methods
A prospective case control study was performed in medical units at National Hospital of Sri Lanka on patients with fever and a positive dengue NS1 antigen test. CCT (PT, APTT & Clauss fibrinogen assay) and ROTEM (EXTEM & INTEM) were performed in patients in febrile phase, on 3rd day of fever, if the platelet count > 100 x 109/L and no features of plasma leakage. Patients enrolled were followed up and if they progressed into critical phase were categorized as “cases” and if they did not (recovered from the febrile phase) categorized as “controls”.
Results
A prospective case control study was performed in medical units at National Hospital of Sri Lanka on patients with fever and a positive dengue NS1 antigen test. CCT (PT, APTT & Clauss fibrinogen assay) and ROTEM (EXTEM & INTEM) were performed in patients in febrile phase, on 3rd day of fever, if the platelet count > 100 x 109/L and no features of plasma leakage. Patients enrolled were followed up and if they progressed into critical phase were categorized as “cases” and if they did not (recovered from the febrile phase) categorized as “controls”.
Conclusion
Conventional coagulation tests were not useful in predicting progression to the critical phase. ROTEM parameters CT & CFT of EXTEM and CFT of INTEM, which can be ascertained at point of care, even in an outpatient setting, in about 10-15 minutes, appeared to be useful in predicting which patient is likely to progress to the critical phase from the febrile phase of dengue fever. When combined, specific cut-off values for each of these 3 parameters gave a NPV of >80% in patients in the febrile phase of dengue fever, on the 3rd day of fever. This preliminary study suggests that a larger study looking at ROTEM parameters, not only on the 3rd day, but also on 4th and 5th days of fever may be useful in predicting which patient with dengue fever is likely to progress to the critical phase.
Keyword(s): Coagulation, Thrombelastograph