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

Najia Hassan, Sujaya Mukhopadhyay, Prasun Bhattacharjee, Rajshree Sinha


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.


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

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