Work

Rotational thromboelastometry performed during the febrile phase of dengue in predicting progression to critical phase: A prospective case control study

Year: 2025

Type: article

Abstract: • Dengue leads to high morbiditiy and mortality, thus became a global health concern. • Morbidity & mortality is due to delay in detecting patients enter critical phase. • Conventional coagulation tests were not useful in prediction of critical phase. • ROTEM delta parameters were able to predict patients unlikely enter critical phase. Dengue is a global health concern. Early identification of patients likely to progress to critical phase help reduce mortality. 136 patients with fever, positive dengue NS1 antigen test, platelet count >100×10 9 /L and no plasma leakage admitted to National Hospital, Sri Lanka had conventional coagulation tests (CCTs); prothrombin time (PT), activated partial thromboplastin time (APTT) & clauss fibrinogen and ROTEM (rotational thromboelastometry) tests; extrinsic coagulation pathway (EXTEM) and intrinsic coagulation pathway (INTEM) on ROTEM delta (EXTEM & INTEM) performed on the third day of fever. Patients were followed up and categorized as “cases” if they progressed to critical phase and “controls” if they didn't. 36 cases and 100 controls were recruited. Results of CCTs were not significant. The three ROTEM delta parameters (clotting time (CT) and clot formation time (CFT) of the EXTEM and CFT of INTEM) had cut-off values with acceptable sensitivities and specificities on receiver operating characteristic curve (ROC) analysis. When combined these parameters predicted patients unlikely to progress into critical phase (negative predictive value of 84.37%). ROTEM delta parameters on 3 rd day of fever predicted progression, whereas CCTs didn't. These parameters generated in about 10 minutes, at the point of care. It would be prudent to substantiate these findings in a larger study. The subclinical coagulopathy evidenced by derangements in ROTEM delta with normal clauss and platelet >100×10 9 /L raises the possibility of platelet dysfunction being the possible cause.

Source: IJID Regions

DOI: 10.1016/j.ijregi.2025.100598