Correlation of Dengue Warning Signs during Febrile Phase with Rotational Thromboelastometry, Cortisol and Feritin

Syarifah Syahirah Syed Abas, Noralisa Abdul Karim, Petrick Periyasamy, Nurasyikin Yusof, Shamsul Azhar Shah, Tan Toh Leong, Saiful Safuan Md Sani, Hanita Othman, Sharifah Azura Salleh, Nurul Nadiah Mohd Zaidi, S Fadilah Abdul Wahid and Wan Fariza Wan Jamaludin
Additional contact information
Syarifah Syahirah Syed Abas: Medical Department, Ampang Hospital, Ampang Jaya 68000, Selangor, Malaysia
Noralisa Abdul Karim: Pusat Terapi Sel, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia
Petrick Periyasamy: Infectious Disease Unit, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia
Nurasyikin Yusof: Hemostasis & Blood Transfusion Unit, Department of Diagnostic Laboratory Services, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia
Shamsul Azhar Shah: Department of Community Health, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia
Tan Toh Leong: Emergency Department, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia
Saiful Safuan Md Sani: Kuala Lumpur General Hospital, Jalan Pahang, Kuala Lumpur 50586, Federal Territory of Kuala Lumpur, Malaysia
Hanita Othman: Chemical Pathology Unit, Department of Diagnostic Laboratory Services, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia
Sharifah Azura Salleh: Infection Control Unit, Department of Medical Microbiology and Immunology, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia
Nurul Nadiah Mohd Zaidi: Pusat Terapi Sel, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia
S Fadilah Abdul Wahid: Pusat Terapi Sel, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia
Wan Fariza Wan Jamaludin: Pusat Terapi Sel, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia

IJERPH, 2022, vol. 19, issue 2, 1-15

Abstract: Dengue mortality remains high despite monitoring against warning signs (WS). The associations of WS at febrile phase (FP) and hemorrhage at defervescence with the levels and kinetics of ROTEM, platelet count, cortisol, and ferritin were analyzed. Patients with confirmed dengue serology and WS in two centers were screened ( n = 275) and 62 eligible patients were recruited prospectively over 9 months. “Vomiting” was the commonest WS (62.9%), with shortened clotting time (CT) INTEM ( p = 0.01). “Hematocrit increase” showed significant prolonged CT INTEM, EXTEM, and FIBTEM ( p < 0.05). “Platelet decrease” showed reduced platelet function and reduced clot amplitude at 10 min (A10) and maximum clot firmness (MCF) in INTEM and EXTEM ( p < 0.001). The kinetics were reduced in platelet count, CT EXTEM, and cortisol ( p < 0.05) but increased in CT INTEM ( p = 0.03). At FP, “vomiting”, “hematocrit increase”, and “platelet decrease” demonstrated impaired CT, clot strengths A10/MCF and platelet functions. Majority (60/62, 96.7%) had non-severe outcomes, consistent with increase in cortisol kinetics. In conclusion, “vomiting”, “hematocrit increase” and “platelet decrease” at FP correlated with ROTEM. No conclusion could be made further regarding ferritin and cortisol. Larger study is required to study “hematocrit increase” with ROTEM as a potential marker for hemorrhage.

Keywords: cortisol; ferritin; dengue hemostasis; severe dengue; ROTEM; warning signs (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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