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

Tun L. Thein 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

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Yee-Sin Leo 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

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Vernon J. Lee 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

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Yan Sun 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

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David C. Lye 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

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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.

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