Early diagnostic indicators of dengue versus other febrile illnesses in Asia and Latin America (IDAMS study): A multicentre, prospective, observational study

Rosenberger, Kerstin D. and Khanh, Lam Phung and Tobian, Frank and Chanpheaktra, Ngoun and Kumar, Varun and Lum, Lucy Chai See and Sathar, Jameela and Sandoval, Ernesto Pleite's and Maron, Gabriela M. and Laksono, Ida Safitri and Mahendradhata, Yodi and Sarker, Malabika and Rahman, Ridwanur and Caprara, Andrea and Benevides, Bruno Souza and Marques, Ernesto T. A. and Magalhaes, Tereza and Brasil, Patricia and Calvet, Guilherme Amaral and Tami, Adriana and Bethencourt, Sarah E. and Hoai, Tam Dong Thi and Thanh, Kieu Nguyen Tan and Van, Ngoc Tran and Tran, Nam Nguyen and Do Chau, Viet and Yacoub, Sophie and Van, Kinh Nguyen and Guzman, Maria G. and Martinez, Pedro A. and Ha, Quyen Nguyen Than and Simmons, Cameron P. and Wills, Bridget A. and Geskus, Ronald B. and Jaenisch, Thomas and Risk, Int Res Consortium Dengue (2023) Early diagnostic indicators of dengue versus other febrile illnesses in Asia and Latin America (IDAMS study): A multicentre, prospective, observational study. Lancet Global Health, 11 (3). e361-e372. ISSN 2214-109X, DOI https://doi.org/10.1016/S2214-109X(22)00514-9.

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Background Improvements in the early diagnosis of dengue are urgently needed, especially in resource-limited settings where the distinction between dengue and other febrile illnesses is crucial for patient management. Methods In this prospective, observational study (IDAMS), we included patients aged 5 years and older with undifferentiated fever at presentation from 26 outpatient facilities in eight countries (Bangladesh, Brazil, Cambodia, El Salvador, Indonesia, Malaysia, Venezuela, and Viet Nam). We used multivariable logistic regression to investigate the association between clinical symptoms and laboratory tests with dengue versus other febrile illnesses between day 2 and day 5 after onset of fever (ie, illness days). We built a set of candidate regression models including clinical and laboratory variables to reflect the need of a comprehensive versus parsimonious approach. We assessed performance of these models via standard measures of diagnostic values. Findings Between Oct 18, 2011, and Aug 4, 2016, we recruited 7428 patients, of whom 2694 (36%) were diagnosed with laboratory-confirmed dengue and 2495 (34%) with (non-dengue) other febrile illnesses and met inclusion criteria, and were included in the analysis. 2703 (52%) of 5189 included patients were younger than 15 years, 2486 (48%) were aged 15 years or older, 2179 (42%) were female and 3010 (58%) were male. Platelet count, white blood cell count, and the change in these variables from the previous day of illness had a strong association with dengue. Cough and rhinitis had strong associations with other febrile illnesses, whereas bleeding, anorexia, and skin flush were generally associated with dengue. Model performance increased between day 2 and 5 of illness. The comprehensive model (18 clinical and laboratory predictors) had sensitivities of 0middot80 to 0middot87 and specificities of 0middot80 to 0middot91, whereas the parsimonious model (eight clinical and laboratory predictors) had sensitivities of 0middot80 to 0middot88 and specificities of 0middot81 to 0middot89. A model that includes laboratory markers that are easy to measure (eg, platelet count or white blood cell count) outperformed the models based on clinical variables only. Interpretation Our results confirm the important role of platelet and white blood cell counts in diagnosing dengue, and the importance of serial measurements over subsequent days. We successfully quantified the performance of clinical and laboratory markers covering the early period of dengue. Resulting algorithms performed better than published schemes for distinction of dengue from other febrile illnesses, and take into account the dynamic changes over time. Our results provide crucial information needed for the update of guidelines, including the Integrated Management of Childhood Illness handbook.

Item Type: Article
Funders: Angkor Hospital for Children, Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia, National Hospital for Tropical Diseases, Hanoi, Viet Nam, Ho Chi Minh City, Viet Nam
Uncontrolled Keywords: Performance; Area
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions: Universiti Malaya Medical Centre (UMMC)
Depositing User: Ms Zaharah Ramly
Date Deposited: 28 Nov 2023 01:38
Last Modified: 28 Nov 2023 01:44
URI: http://eprints.um.edu.my/id/eprint/38548

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