Core-Peripheral Temperature Gradient And Blood Lactate Level As Markers Of Prognosis In Children With Dengue

BACKGROUNDSevere Dengue is an important cause of childhood morbidity in many tropical regions. Dengue virus (DENV) infection leads to a range of outcomes including subclinical infection, undifferentiated febrile illness, Dengue fever (DF), life-threatening syndromes with fluid loss and hypotensive shock or other severe manifestations such as bleeding and organ failure. It therefore becomes essentially important to identify a child with physiological derangements in the early stages when signs are subtle, to monitor for warning signs and other clinical parameters in order to recognise progression to the critical phase and therefore predictability of mortality in the early stages when the symptoms are not very marked. The aim of the study was to assess the utility of non-invasive, inexpensive clinical methods, arterial lactate level and coreperipheral temperature gradient as prognostic indicators in children with dengue.MATERIALS AND METHODSThis was a prospective observational study conducted in the paediatric emergency ward/ICU of Department of Paediatrics, GSVM Medical College, Kanpur. Subjects were all suspected cases of dengue aged between 1 year and 18 years, attending the paediatric emergency ward/ICU of Dept. of Paediatrics between 1st July 2014 and 31st June 2015. Arterial lactate level and core-peripheral temperature gradient of confirmed cases were recorded at the time of admission. ROC analysis and multiple logistic regression analysis were used to analyse the data.RESULTSOut of 115 confirmed dengue cases, 16 patients were lost for followup. Of the remaining 99 cases, there were 67 males and 32 females in the range of age group of 1 year to 18 years. Mean age of males was 6.02 +/- 3.28 years and mean age of females was 10.28 +/- 3.85 years. ROC curve analysis showed that core to peripheral temperature gradient and arterial lactate levels had similar predictive values for increased risk of mortality (area under the curve, 0.807 and 0.877, respectively) with the best cut-off values of 2.9(0)C for core to peripheral temperature gradient and 36 mg/dL for blood lactate levels.CONCLUSIONRaised arterial lactate levels above 36 mg/dL and core to peripheral temperature gradient >= 2.9(0)C have a good prognostic value as a marker of mortality children with dengue.