Postural fall in systolic blood pressure is an useful warning sign in Dengue fever

Purpose: Capillary leak is the hallmark of development of severe dengue. A rise in hematocrit has been a major warning sign in WHO guidelines. Postural hypotension, which could reflect the intravascular volume reduction in capillary leak, has been noted as a warning sign in CDC and Pan American Health Organisation guidelines. We evaluated the diagnostic accuracy of Postural hypotension as a marker of development of severe dengue.
Methods: 150 patients admitted with dengue fever were recruited in this prospective observational study. Diagnostic accuracy of conventional warning signs (abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, liver enlargement, increasing hematocrit with decreasing platelets) and postural hypotension was evaluated.
Result: 23 (15.3%) subjects developed severe dengue. Multiple logistic regression analysis showed that Ascites/Pleural effusion and postural fall in systolic blood pressure of >10.33% had an odds ratio of 5.024(95%C..., Patients admitted to hospital with Dengue fever as per WHO criteria were included in this prospective observational study. Patients with NS1 antigen-positive results or positive Dengue IgM ELISA reports were included. Patients having severe dengue on admission were excluded. Descriptive clinical data regarding atypical manifestations of Dengue among these patients was published earlier. Analytical data regarding the diagnostic performance of warning clinical signs and postural hypotension are presented in this paper. The rise in hematocrit was calculated by comparing the hematocrit after admission with population mean values. Mean baseline hematocrit for South Indian males was 44.3% and for females 36.4%. A rise of 20% compared to the baseline hematocrit was considered significant (53.2% for males and 43.7% for Females) Patients were treated as per the WHO 2009 Protocol for the management of Dengue. Patients were followed up until they recovered or succumbed to the illness. Patients who...,