Abstract Ref Number = APCP263
RISK FACTORS OF MORTALITY AMONG DENGUE SHOCK SYNDROME PATIENTS WITH DISSEMINATED INTRAVASCULAR COAGULATION AT DR SARDJITO GENERAL HOSPITAL
Singgih Setiawan,Syahru Agung Setiawan,Eggi Arguni,Agnes Muryanti,Sutaryo
Faculty of Medicine Public Health and Nursing Universitas Gadjah Mada Dr Sardjito General Hospital
Background : Dengue is one of the most serious and rapidly emerging tropical mosquito-borne diseases with over 20,000 dengue related deaths annually. Dengue shock syndrome (DSS) is associated with the increase of vascular permeability and plasma leakage. This causes thrombocytopenia and loss of clotting factors, which result in bleeding. Disseminated intravascular coagulation (DIC) often occurs as a terminal event.
Material : A retrospective descriptive study was conducted in all confirmed DSS with DIC patients at Department of Child Health, Dr. Sardjito General Hospital during 2014 to 2016. They were categorized into two groups, DSS with DIC who survived and DSS with DIC who deceased. The risk factors associated with them were analyzed.
Results : Fifty three children diagnosed with DSS were also admitted with DIC. There were 19 (35.85%) deaths among them. Various clinical and laboratory parameters were analyzed between the two groups and a p value <0.05 was considered as significant. The associated risk factors for death in DSS with DIC patients on univariate analysis were epistaxis [odds ratio (OR) 1.64, 95% confidence interval (CI): 0.38-7.11, p=0.03), hepatomegaly (OR 1.2, 95% CI: 0.14-0.98, p=0.04), prolonged (? 3 seconds) partial thromboplastin time (PTT) (OR 14.5, 95% CI: 3.64-57.56, p=0.001), and prolonged (? 5 seconds) activated partial thromboplastin time (aPTT) (OR 4.7, 95% CI: 1.16-19.32, p=0.03). On multivariate analysis, prolonged (? 5 seconds) aPTT (OR 3.59, 95% CI: 3.17-55.7, p < 0,001) was seen as the most common risk factor associated with death in DSS with DIC patients.
Conclusions : Activated partial thromboplastin time prolongation for ? 5 seconds was significantly associated with higher mortality in DSS patients with DIC independently. Early identification of this feature, monitoring, and prompt management are needed to save DSS patient with DIC.
Keywords: dengue shock syndrome disseminated intravascular coagulation mortality risk factors