Abstract
OBJECTIVES: To identify the prevalence and potential predictive factors of severe dengue among children in Vietnam. METHODS: A retrospective study was conducted at Thai Binh Pediatric Hospital, in children from 0 to 16 years, hospitalized for dengue infection from January 2023 to December 2024. Dengue severity was classified according to WHO 2009 guidelines. Potential predictive factors of severe disease were investigated using logistic regression. RESULTS: A total of 332 children hospitalized for dengue infection were included: median age was 14 months and male gender accounted for 63.0% of the patients. 15.1% (n=50) presented with dengue with warning sign (DWS). None of the children developed severe dengue. The mean time from symptom onset to diagnosis of DWS was 4.0 ± 2.3 days. The most common clinical manifestations in DWS cases were right upper quadrant abdominal pain (34.0%), rapid decrease in platelet count (32.0%), and hepatomegaly (26.0%). Thrombocytopenia at admission was independent predictor (OR = 13.36, 95%CI [4.26-41.88]. Children older than five years and female patients also had higher odds of DWS (OR = 11.21, 95%CI [4.71-26.66] and OR = 2.32, 95%CI [1.05-5.13], respectively. Elevated hematocrit, hypoalbuminemia, elevated transaminases, abnormal nutritional status, petechiae and admission at ≥ 4 days from symptom onset were not associated with DWS after adjustment. The model achieved a sensitivity of 74% and a specificity of 92%, corresponding to an area under the receiver-operating-characteristic curve of 0.83, giving an overall accuracy of 89.5%. CONCLUSIONS: Our findings identified predictive factors of DWS among children, especially low platelet count at admission is proposed as a practical tool for predicting DWS. This makes a practical tool for early risk stratification and resource allocation in settings with limited laboratory capacity in low- and middle-income countries.