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Factors associated with thrombocytopenia in patients with dengue fever: a retrospective cohort study.

ABSTRACT: OBJECTIVE:Some patients with dengue fever tend to develop thrombocytopenia during the course of infection and are thus vulnerable to haemorrhagic manifestations and other complications. However, the factors associated with the development of thrombocytopenia are unknown. We aimed to identify factors associated with an increased risk of thrombocytopenia and haematological changes in patients with confirmed dengue fever. DESIGN:Retrospective cohort study. SETTING:Brazilian multicentre primary care databases. PARTICIPANTS:387 patients had positive laboratory serological confirmation of dengue infection during 2014. The data were identified from two databases: Notification of Injury Information System (SINAN) and Municipal Laboratory. MAIN OUTCOME MEASURE:The presence of thrombocytopenia (platelet count <1?50×109/L). The associations of factors that predisposed patients to thrombocytopenia and haematological changes were analysed using logistic regression. ORs and 95% CIs were calculated. RESULTS:Among 387 patients, 156 had both dengue and thrombocytopenia. The risk factors associated with thrombocytopenia included male sex (OR: 1.77, 95%?CI: 1.16 to 2.71, p=0.007), age of 46-64 years (OR: 2.20, 95%?CI: 1.15 to 4.21, p=0.009) or ?65 years (OR: 3.02, 95%?CI: 1.40 to 6.50, p=0.002), presence of leucopenia (OR: 6.85, 95%?CI: 4.27 to 10.99, p<0.001) and high mean corpuscular haemoglobin (MCH) levels (OR: 2.00, 95%?CI: 1.29 to 3.12, p=0.005). CONCLUSION:Older age, male sex, presence of leucopenia and high MCH levels were identified as risk factors associated with the development of thrombocytopenia in this population.

SUBMITTER: Castilho BM

PROVIDER: S-EPMC7488788 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Factors associated with thrombocytopenia in patients with dengue fever: a retrospective cohort study.

Castilho Bruna M BM Silva Marcus T MT Freitas André R R ARR Fulone Izabela I Lopes Luciane Cruz LC

BMJ open 20200913 9

<h4>Objective</h4>Some patients with dengue fever tend to develop thrombocytopenia during the course of infection and are thus vulnerable to haemorrhagic manifestations and other complications. However, the factors associated with the development of thrombocytopenia are unknown. We aimed to identify factors associated with an increased risk of thrombocytopenia and haematological changes in patients with confirmed dengue fever.<h4>Design</h4>Retrospective cohort study.<h4>Setting</h4>Brazilian mu ...[more]

PMID: 32928847

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Project description:BACKGROUND:The incidence of dengue is rising steadily in Malaysia since the first major outbreak in 1973. Despite aggressive measures taken by the relevant authorities, Malaysia is still facing worsening dengue crisis over the past few years. There is an urgent need to evaluate dengue cases for better understanding of clinic-laboratory spectrum in order to combat this disease. METHODS:A retrospective analysis of dengue patients admitted to a tertiary care teaching hospital during the period of six years (2008 - 2013) was performed. Patient's demographics, clinical and laboratory findings were recorded via structured data collection form. Patients were categorized into dengue fever (DF) and dengue hemorrhagic fever (DHF). Appropriate statistical methods were used to compare these two groups in order to determine difference in clinico-laboratory characteristics and to identify independent risk factors of DHF. RESULTS:A total 667 dengue patients (30.69?±?16.13 years; Male: 56.7 %) were reviewed. Typical manifestations of dengue like fever, myalgia, arthralgia, headache, vomiting, abdominal pain and skin rash were observed in more than 40 % patients. DHF was observed in 79 (11.8 %) cases. Skin rash, dehydration, shortness of breath, pleural effusion and thick gall bladder were more significantly (P?<?0.05) associated with DHF than DF. Multivariate regression analysis demonstrated presence of age?>?40 years (OR: 4.1, P?<?0.001), secondary infection (OR: 2.7, P?=?0.042), diabetes mellitus (OR: 2.8, P?=?0.041), lethargy (OR: 3.1, P?=?0.005), thick gallbladder (OR: 1.7, P?=?0.029) and delayed hospitalization (OR: 2.3, P?=?0.037) as independent predictors of DHF. Overall mortality was 1.2 % in our study. CONCLUSIONS:Current study demonstrated that DF and DHF present significantly different clinico-laboratory profile. Older age, secondary infection, diabetes mellitus, lethargy, thick gallbladder and delayed hospitalization significantly predict DHF. Prior knowledge of expected clinical profile and predictors of DHF/DSS development would provide information to identify individuals at higher risk and on the other hand, give sufficient time to clinicians for reducing dengue related morbidity and mortality.

Project description:Severe neonatal thrombocytopenia is a rare disease with multiple etiologies. Severe thrombocytopenia with bleeding is life-threatening and has attracted significant attention from clinicians. However, only a few studies have focused on the association between severe thrombocytopenia and bleeding. Thus, this study aimed to describe the neonates' postnatal age at which severe thrombocytopenia was first recognized, clinical characteristics, bleeding patterns, and outcomes and to evaluate the association between minimum platelet count and bleeding. A single-center retrospective cohort study for neonates with severe thrombocytopenia (platelet count ≤ 50 × 109/L) was conducted. Neonates who were admitted to our neonatal intensive care unit between October 2016 and February 2021 and developed severe thrombocytopenia were analyzed. Data were collected retrospectively until the patients were referred to other hospitals, discharged, or deceased. Among the 5819 neonatal inpatients, 170 with severe thrombocytopenia were included in this study. More than 30% of the patients had severe thrombocytopenia in the first 3 days of life. Among the 118 neonates with bleeding, 47 had more than one type of pathological bleeding. Neonates with very severe thrombocytopenia (point estimate: 53.7%, 95% confidence interval [CI]: 44.2%-63.1%) had a higher incidence rate of cutaneous bleeding than those with severe thrombocytopenia (point estimate: 23.4%, 95% CI: 12.3%-34.4%). The gestational age (median: 36.2 [interquartile range [IQR]: 31.4-39.0] weeks) and birth weight (median: 2310 [IQR: 1213-3210] g) of the major bleeding group were the lowest among no bleeding, minor bleeding, and major bleeding groups. Regression analysis controlled for confounders and confirmed that a lower platelet count (odds ratio [OR]: 2.504 [95% CI: 1.180-5.314], P = 0.017) was associated with a significant increase in the rate of bleeding. Very severe thrombocytopenia (point estimate: 49.1%, 95% CI: 39.6%-58.6%) had a higher rate of platelet transfusion than severe thrombocytopenia (point estimate: 5.7%, 95% CI: 0.7%-10.7%). The mortality rate was higher in neonates with bleeding than in those without bleeding (point estimates with 95% CI: 33.1% [24.4%-41.7%] vs. 7.7% [0.2%-15.2%]). These findings describe the incidence of severe thrombocytopenia and demonstrate that a lower platelet count is associated with an increased bleeding rate in patients with severe thrombocytopenia.

Dataset Information

Factors associated with thrombocytopenia in patients with dengue fever: a retrospective cohort study.

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Factors associated with thrombocytopenia in patients with dengue fever: a retrospective cohort study.

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