Bed side prognostic markers for dengue fever: serum lactate, base excess and central peripheral temperature gradient


  • Najia Hassan Department of Pediatrics, School of Medical Sciences and Research, Greater Noida, Uttar Pradesh, India
  • Sujaya Mukhopadhyay Department of Pediatrics, School of Medical Sciences and Research, Greater Noida, Uttar Pradesh, India
  • Prasun Bhattacharjee Department of Pediatrics, IPGMER, Kolkata, West Bengal, India
  • Rajshree Sinha MBBS final year student, School of Medical Sciences and Research, Greater Noida, Uttar Pradesh, India



Central peripheral temperature gradient, DSS, DHF, Greater Noida, Prognostic factors, Severe dengue fever


Background: Dengue is a common systemic viral infection, which has achieved epidemic proportion in India. The manifestations are varied, is most often a simple febrile illness, but at times it can be severe with hypovolemic shock resulting from excessive plasma leakage. Dengue shock syndrome is potentially fatal, with mortality ranging from <1% to 10%. The key to a good clinical outcome is understanding and being alert to the clinical problems that arise during the different phases of the disease, leading to a rational approach in case management. Investigations which can help in prognostication if used sequentially can be very effective in management. Serum lactate, base excess and central peripheral temperature gradient are few such markers which can help in identifying at risk patients.

Methods: In this study children in the age group of 6 months to 18 years, admitted in School of Medical Sciences and Research with complains of fever and found to be positive for dengue as per Ag/serology study were included. The study was done over a period of one year from August 2015 to August 2016. ABG/VBG for Serum lactate and base excess was done in all patients on confirmation of diagnosis of dengue and on progression of disease. Also, central and peripheral temperatures were measured.

Results: A total of 524 patients were enrolled. 77.29% were of dengue fever. 14.50% of dengue hemorrhagic fever and 8.21% were of dengue shock syndrome. Mean central and peripheral temperature difference was found to be higher for patients with DSS than with DHF and DF. High Lactate levels was found to be 100% sensitive and specific for mortality, likewise decreasing base excess was found to be 84.62% sensitive and 90.56% specific for mortality. Cp-T difference had sensitivity of 100% and specificity of 96.59%. All three had p-value of 0.01 which is significant.

Conclusions: A single ABG/VBG analysis can give values for Serum lactate and base excess both of which are very good indicators of intravascular fluid status and are easily available. Done sequentially, these tests can predict progression of dengue fever. Likewise, temperature gradient is not so expensive tool. Used properly, is very effective monitoring method.


Simmons CP, Farrar JJ, Nguyen van VC, Dengue WB. N Engl J Med. 2012;366:1423-32.

World Health Organization. Dengue and severe dengue. 2012. Available at

Bunnag T, Kalayanarooj S. Dengue shock syndrome at the emergency room of Queen Sirikit National Institute of Child Health, Bangkok, Thailand. J Med Assoc Thai. 2011;94(3):S57-S63.

Ranjit S, Kissoon N, Jayakumar I. Aggressive management of dengue shock syndrome may decrease mortality rate: a suggested protocol. Pediatr Crit care Med. 2005;6:412-9.

Wills B, Nguyen MD, Ha TL, Dong THT, Tran TNT, Le TTM, et al. Comparison of three fluid solutions for resuscitation in dengue shock syndrome. N Engl J Med. 2005;353:877-89.

Anders KL, Nguyet NM, Chau NVV, Hung NT, Thuy TT, Lien LB, et al. Epidemiological factors associated with dengue shock syndrome and mortality in hospitalized dengue patients in Ho Chi Minh City, Vietnam. Am J Trop Med Hyg. 2011;84:127-34.

Oishi K, Mapua CA, Carlos CC, Cinco-Abanes MT, Saoto M, Inoue S, et al. Dengue and other febrile illnesses among children in the Philippines. Dengue Bulletin. 2006;30:26-34.

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368-77.

Poeze M, Solberg BC, Greve JW, Ramsay G. Monitoring global volume-related hemodynamic or regional variables after initial resuscitation: What is a better predictor of outcome in critically ill septic patients? Crit Care Med. 2005;33(11):2494-500.

Varpula M, Tallgren M, Saukkonen K, Voipio-Pulkki LM, Pettila V. Hemodynamic variables related to outcome in septic shock. Intensive Care Med. 2005;31(8):1066-71.

Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, et al. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med. 2004;32(3):858-73.

Englehart MS, Schreiber MA. Measurement of acid-base resuscitation endpoints: lactate, base deficit, bicarbonate, or what? Curr Opin Crit Care. 2006;12:569-74.

Forni LG, McKinnon W, Lord GA, Treacher DF, Peron JM, Hilton PJ. Circulating anions usually associated with the Krebs cycle in patients with metabolic acidosis. Crit Care. 2005;9:R591-5.

Wijaya R, Ng JH, Ong L, Wong ASY. Can venous base excess replace arterial base excess as a marker of early shock and a predictor of survival in trauma?. Singapore Med J. 2016;57(2):73-6.

Tibby SM, Hatherill M, Murdoch IA. Capillary refill and core-peripheral temperature gap as indicators of haemodynamic status in paediatric intensive care patients. Arch Dis Child. 1999;80:163-6.

Hoffman RJ, Etwaru K, Dreisinger N, Khokhar A, Husk G. Comparison of temporal artery thermometry and rectal thermometry in febrile pediatric emergency department patients. Pediatr Emerg Care. 2013;29(3):301-4.

Reynolds M, Bonham L, Gueck M. Are temporal artery temperatures accurate enough to replace rectal temperature measurement in pediatric ED patients?. J Emerg Nurs. 2014;40(1):46-50.

Romano MJ, Fortenberry JD, Autrey E, et al. Infrared tympanic thermometry in the pediatric intensive care unit. Crit Care Med. 1993;21:1181-5.

Erickson RS, Woo TM. Accuracy of infrared thermometry and traditional temperature methods in young children. Heart Lung. 1994;23:181-95.

Chamberlain JM, Terndrup TE, Alexander DT, Silverstone FA, Wolf-Klein G, O'Donnell R, et al. Determination of normal ear temperature with an infrared emisssion detection thermometer. Ann Emerg Med. 1995;25:15-20.

Terndrup T, Crofton D, Mortelliti A, Kelley R, Rajk J. Estimation of contact tympanic membrane temperature with a noncontact infrared thermometer. Ann Emerg Med. 1997;30:171-5.

Childs C, Harrison R, Hodkinson C. Tympanic membrane temperature as a measure of core temperature. Arch Dis Child. 1999;80:262-6.

Pongpan S, Wisitwong A, Tawichasri C, Patumanond J. Prognostic indicators for dengue infection severity. Int J Clin Pediatr. 2013;2(1):12-8.

Huckabee WE. Abnormal resting blood lactate. The significance of hyperlactatemia in hospitalized patients. Am J Med. 1961;30:840-8.

Shapiro NI, Howell MD, Talmor D, et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med. 2005;45(5):524-8.

Ross BA, Brock, Aynsley-Green A. Observations on central and peripheral temperature in the understanding and management of shock. Br J Surg. 1969;56:877-82.

Joly HR, Weil MH. Temperature of the great toe as an indication of the severity of shock. Circ. 1967;39:131-8.

Woods I, Wilkins RG, Edwards JD, Martin PD, Faragher EB. Danger of using core/peripheral temperature gradient as a guide to therapy in shock. Crit Care Med. 1987;15:850-2.

Aynsley-Green A, Pickering D. Use of central and peripheral temperature measurements in care of the critically ill child. Arch Dis Child. 1974;49:447-81.






Original Research Articles