• 1.

    Shah I, Deshpande GC, Tardeja PN, 2004. Outbreak of dengue in Mumbai and predictive markers for dengue shock syndrome. J Trop Pediatr 50: 301305.

    • Search Google Scholar
    • Export Citation
  • 2.

    Wills BA, Nguyen MD, Ha TL, Dong TH, Tran TN, Le TT, Tran VD, Nguyen TH, Nguyen VC, Stepniewska K, White NJ, Farrar JJ, 2005. Comparison of three fluid solutions for resuscitation in dengue shock syndrome. N Engl J Med 353: 877889.

    • Search Google Scholar
    • Export Citation
  • 3.

    Thein S, Aung MM, Shwe TN, Aye M, Zaw A, Aye K, Aye KM, Aaskov J, 1997. Risk factors in dengue shock syndrome. Am J Trop Med Hyg 56: 566572.

  • 4.

    Guzman MG, Kouri GP, Bravo J, Soler M, Vazquez S, Morier L, 1990. Dengue hemorrhagic fever in Cuba, 1981: a retrospective seroepidemiologic study. Am J Trop Med Hyg 42: 179184.

    • Search Google Scholar
    • Export Citation
  • 5.

    Watts DM, Porter KR, Putvatana P, Vasquez B, Calampa C, Hayes CG, Halstead SB, 1999. Failure of secondary infection with American genotype dengue 2 to cause dengue haemorrhagic fever. Lancet 354: 14311434.

    • Search Google Scholar
    • Export Citation
  • 6.

    Burke DS, Nisalak A, Johnson DE, Scott RM, 1988. A prospective study of dengue infections in Bangkok. Am J Trop Med Hyg 38: 172180.

  • 7.

    Guzman MG, Kouri G, Bravo J, Valdes L, Vazquez S, Halstead SB, 2002. Effect of age on outcome of secondary dengue 2 infections. Int J Infect Dis 6: 118124.

    • Search Google Scholar
    • Export Citation
  • 8.

    Ooi EE, Goh KT, Chee Wang DN, 2003. Effect of increasing age on the trend of dengue and dengue hemorrhagic fever in Singapore. Int J Infect Dis 7: 231232.

    • Search Google Scholar
    • Export Citation
  • 9.

    Guzman MG, Kouri GP, Bravo J, Soler M, Vazquez S, Santos M, Villaescusa R, Basanta P, Indan G, Ballester JM, 1984. Dengue haemorrhagic fever in Cuba. II. Clinical investigations. Trans R Soc Trop Med Hyg 78: 239241.

    • Search Google Scholar
    • Export Citation
  • 10.

    Ministry of Health, 2005. Epidemiology News Bulletin. Singapore: Ministry of Health.

  • 11.

    Ministry of Health, 2006. Communicable Disease Surveillance in Singapore 2005. Singapore: Ministry of Health.

  • 12.

    Carlos CC, Oishi K, Cinco MT, Mapua CA, Inoue S, Cruz DJ, Pancho MA, Tanig CZ, Matias RR, Morita K, Natividad FF, Igarashi A, Nagatake T, 2005. Comparison of clinical features and hematologic abnormalities between dengue fever and dengue hemorrhagic fever among children in the Philippines. Am J Trop Med Hyg 73: 435440.

    • Search Google Scholar
    • Export Citation
  • 13.

    Kalayanarooj S, Vaughn DW, Nimmannitya S, Green S, Suntayakorn S, Kunentrasai N, Viramitrachai W, Ratanachu-eke S, Kiatpolpoj S, Innis BL, Rothman AL, Nisalak A, Ennis FA, 1997. Early clinical and laboratory indicators of acute dengue illness. J Infect Dis 176: 313321.

    • Search Google Scholar
    • Export Citation
  • 14.

    Lee MS, Hwang KP, Chen TC, Lu PL, Chen TP, 2006. Clinical characteristics of dengue and dengue hemorrhagic fever in a medical center of southern Taiwan during the 2002 epidemic. J Microbiol Immunol Infect 39: 121129.

    • Search Google Scholar
    • Export Citation
  • 15.

    Teeraratkul A, Limpakarnjanaral K, Nisalak A, Nimmannitya S, 1990. Predictive value of clinical and laboratory findings for early diagnosis of dengue and dengue hemorrhagic fever. Southeast Asian J Trop Med Public Health 21: 696697.

    • Search Google Scholar
    • Export Citation
  • 16.

    Lee VJ, Lye DC, Sun Y, Fernandez G, Ong A, Leo YS, 2008. Predictive value of simple clinical and laboratory variables for dengue hemorrhagic fever in adults. J Clin Virol 42: 3439.

    • Search Google Scholar
    • Export Citation
  • 17.

    Lee VJ, Lye DC, Sun Y, Leo YS, 2009. Decision tree algorithm in deciding hospitalization for adult patients with dengue hemorrhagic fever in Singapore. Trop Med Int Health 14: 11541159.

    • Search Google Scholar
    • Export Citation
  • 18.

    Lee KS, Lai YL, Lo S, Barkham T, Aw P, Ooi PL, Tai JC, Hibberd M, Johansson P, Khoo SP, Ng LC, 2010. Dengue virus surveillance for early warning, Singapore. Emerg Infect Dis 16: 847849.

    • Search Google Scholar
    • Export Citation
  • 19.

    World Health Organization, 1997. Dengue Haemorrhagic Fever: Diagnosis, Treatment, Prevention and Control. Second edition. Geneva: World Health Organization.

    • Search Google Scholar
    • Export Citation
  • 20.

    Blacksell SD, Newton PN, Bell D, Kelley J, Mammen MP Jr, Vaughn DW, Wuthiekanun V, Sungkakum A, Nisalak A, Day NP, 2006. The comparative accuracy of 8 commercial rapid immunochromatographic assays for the diagnosis of acute dengue virus infection. Clin Infect Dis 42: 11271134.

    • Search Google Scholar
    • Export Citation
  • 21.

    Cuzzubbo AJ, Endy TP, Nisalak A, Kalayanarooj S, Vaughn DW, Ogata SA, Clements DE, Devine PL, 2001. Use of recombinant envelope proteins for serological diagnosis of dengue virus infection in an immunochromatographic assay. Clin Diagn Lab Immunol 8: 11501155.

    • Search Google Scholar
    • Export Citation
  • 22.

    Barkham TM, Chung YK, Tang KF, Ooi EE, 2006. The performance of RT-PCR compared with a rapid serological assay for acute dengue fever in a diagnostic laboratory. Trans R Soc Trop Med Hyg 100: 142148.

    • Search Google Scholar
    • Export Citation
  • 23.

    World Health Organization, 2009. Dengue: guidelines for diagnosis, treatment, prevention and control. New edition. Geneva: World Health Organization.

    • Search Google Scholar
    • Export Citation
  • 24.

    Kumar SR, Patil JA, Cecilia D, Cherian SS, Barde PV, Walimbe AM, Yadav PD, Yergolkar PN, Shah PS, Padbidri VS, Mishra AC, Mourya DT, 2010. Evolution, dispersal and replacement of American genotype dengue type 2 viruses in India (1956–2005): selection pressure and molecular clock analyses. J Gen Virol 91: 707720.

    • Search Google Scholar
    • Export Citation
  • 25.

    Salda LT, Parquet MD, Matias RR, Natividad FF, Kobayashi N, Morita K, 2005. Molecular epidemiology of dengue 2 viruses in the Philippines: genotype shift and local evolution. Am J Trop Med Hyg 73: 796802.

    • Search Google Scholar
    • Export Citation
  • 26.

    Vu TT, Holmes EC, Duong V, Nguyen TQ, Tran TH, Quail M, Churcher C, Parkhill J, Cardosa J, Farrar J, Wills B, Lennon NJ, Birren BW, Buchy P, Henn MR, Simmons CP, 2010. Emergence of the Asian 1 genotype of dengue virus serotype 2 in Viet Nam: in vivo fitness advantage and lineage replacement in South-East Asia. PLoS Negl Trop Dis 4: e757.

    • Search Google Scholar
    • Export Citation
  • 27.

    Mota J, Rico-Hesse R, 2009. Humanized mice show clinical signs of dengue fever according to infecting virus genotype. J Virol 83: 86388645.

    • Search Google Scholar
    • Export Citation
  • 28.

    Anderson JR, Rico-Hesse R, 2006. Aedes aegypti vectorial capacity is determined by the infecting genotype of dengue virus. Am J Trop Med Hyg 75:886892.

    • Search Google Scholar
    • Export Citation
  • 29.

    Low JG, Ooi EE, Tolfvenstam T, Leo YS, Hibberd ML, Ng LC, Lai YL, Yap GS, Li CS, Vasudevan SG, Ong A, 2006. Early dengue infection and outcome study (EDEN)—study design and preliminary findings. Ann Acad Med Singapore 35: 783789.

    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 262 116 8
PDF Downloads 57 33 1
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

 

Validation of Probability Equation and Decision Tree in Predicting Subsequent Dengue Hemorrhagic Fever in Adult Dengue Inpatients in Singapore

View More View Less
  • Communicable Disease Center, Tan Tock Seng Hospital, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore; Department of Epidemiology and Public Health, National University of Singapore, Singapore; Clinical Project Management and Planning, National Healthcare Group, Singapore
Restricted access

We developed a probability equation and a decision tree from 1,973 predominantly dengue serotype 1 hospitalized adult dengue patients in 2004 to predict progression to dengue hemorrhagic fever (DHF), applied in our clinic since March 2007. The parameters predicting DHF were clinical bleeding, high serum urea, low serum protein, and low lymphocyte proportion. This study validated these in a predominantly dengue serotype 2 cohort in 2007. The 1,017 adult dengue patients admitted to Tan Tock Seng Hospital, Singapore had a median age of 35 years. Of 933 patients without DHF on admission, 131 progressed to DHF. The probability equation predicted DHF with a sensitivity (Sn) of 94%, specificity (Sp) 17%, positive predictive value (PPV) 16%, and negative predictive value (NPV) 94%. The decision tree predicted DHF with a Sn of 99%, Sp 12%, PPV 16%, and NPV 99%. Both tools performed well despite a switch in predominant dengue serotypes.

Author Notes

*Address correspondence to Tun L. Thein, Communicable Disease Center, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. E-mail: linn_thein_tun@ttsh.com.sg

Financial support: This study was funded by National Medical Research Council, Singapore, grant no. NMRC/TCR/005.

Authors' addresses: Tun L. Thein, Communicable Disease Center, Tan Tock Seng Hospital, Singapore, E-mail: linn_thein_tun@ttsh.com.sg. Yee-Sin Leo and David C. Lye, Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, E-mails: yee_sin_leo@ttsh.com.sg and david_lye@ttsh.com.sg. Vernon J. Lee, Department of Clinical Epidemiology, Tan Tock Seng Hospital, and Department of Epidemiology and Public Health, National University of Singapore, Singapore, E-mail: vernonljm@hotmail.com. Yan Sun, Clinical Project Management and Planning, National Healthcare Group, Singapore, E-mail: yan_sun@nhg.com.sg.

Save