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Development of clinical decision rules to predict recurrent shock in dengue

Critical care (London, England), 2013-12, Vol.17 (6), p.R280-280 [Peer Reviewed Journal]

COPYRIGHT 2013 BioMed Central Ltd. ;Copyright © 2013 Huy et al.; licensee BioMed Central Ltd. 2013 Huy et al.; licensee BioMed Central Ltd. ;ISSN: 1364-8535 ;EISSN: 1466-609X ;DOI: 10.1186/cc13135 ;PMID: 24295509

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Title:
Development of clinical decision rules to predict recurrent shock in dengue
Author: Huy, Nguyen Tien ; Thao, Nguyen Thanh Hong ; Ha, Tran Thi Ngoc ; Lan, Nguyen Thi Phuong ; Nga, Phan Thi Thanh ; Thuy, Tran Thi ; Tuan, Ha Manh ; Nga, Cao Thi Phi ; Tuong, Vo Van ; Dat, Tran Van ; Huong, Vu Thi Que ; Karbwang, Juntra ; Hirayama, Kenji
Subjects: Ascites - etiology ; Care and treatment ; Decision Support Techniques ; Decision-making ; Dengue ; Dengue - complications ; Ecchymosis - etiology ; Health aspects ; Hospitalization ; Humans ; Logistic Models ; Medical research ; Medicine, Experimental ; Medicine, Preventive ; Patient outcomes ; Platelet Count ; Pleural Effusion - etiology ; Preventive health services ; Psychological aspects ; Pulse ; Purpura - etiology ; Recurrence ; Risk factors ; Shock ; Shock - diagnosis ; Shock - etiology ; Time Factors
Is Part Of: Critical care (London, England), 2013-12, Vol.17 (6), p.R280-280
Description: Mortality from dengue infection is mostly due to shock. Among dengue patients with shock, approximately 30% have recurrent shock that requires a treatment change. Here, we report development of a clinical rule for use during a patient's first shock episode to predict a recurrent shock episode. The study was conducted in Center for Preventive Medicine in Vinh Long province and the Children's Hospital No. 2 in Ho Chi Minh City, Vietnam. We included 444 dengue patients with shock, 126 of whom had recurrent shock (28%). Univariate and multivariate analyses and a preprocessing method were used to evaluate and select 14 clinical and laboratory signs recorded at shock onset. Five variables (admission day, purpura/ecchymosis, ascites/pleural effusion, blood platelet count and pulse pressure) were finally trained and validated by a 10-fold validation strategy with 10 times of repetition, using a logistic regression model. The results showed that shorter admission day (fewer days prior to admission), purpura/ecchymosis, ascites/pleural effusion, low platelet count and narrow pulse pressure were independently associated with recurrent shock. Our logistic prediction model was capable of predicting recurrent shock when compared to the null method (P < 0.05) and was not outperformed by other prediction models. Our final scoring rule provided relatively good accuracy (AUC, 0.73; sensitivity and specificity, 68%). Score points derived from the logistic prediction model revealed identical accuracy with AUCs at 0.73. Using a cutoff value greater than -154.5, our simple scoring rule showed a sensitivity of 68.3% and a specificity of 68.2%. Our simple clinical rule is not to replace clinical judgment, but to help clinicians predict recurrent shock during a patient's first dengue shock episode.
Publisher: England: BioMed Central Ltd
Language: English
Identifier: ISSN: 1364-8535
EISSN: 1466-609X
DOI: 10.1186/cc13135
PMID: 24295509
Source: MEDLINE
PubMed Central
Alma/SFX Local Collection
Springer OA刊
DOAJ Directory of Open Access Journals

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Development of clinical decision rules to predict recurrent shock in dengue

COPYRIGHT 2013 BioMed Central Ltd. ;Copyright © 2013 Huy et al.; licensee BioMed Central Ltd. 2013 Huy et al.; licensee BioMed Central Ltd. ;ISSN: 1364-8535 ;EISSN: 1466-609X ;DOI: 10.1186/cc13135 ;PMID: 24295509

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