{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T15:45:30Z","timestamp":1793202330554,"version":"4.5.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2020,9,23]],"date-time":"2020-09-23T00:00:00Z","timestamp":1600819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Taking into consideration, the variable performance of WHO\u2019s dengue case definition and the magnitude of epidemics in India, a score based on clinical and laboratory parameters is required for the early identification of severe dengue.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A retrospective observational study of children (aged \u226412 y) presenting with dengue, defined as per the WHO 2009 classification and NS1 antigen\/IgM ELISA positivity, was conducted at a tertiary care hospital from 2013 to 2015. Clinical laboratory parameters were compared between severe\/non-severe dengue using univariate and multivariate analysis. Areas under receiver operating characteristic curves (AUROCs), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were obtained for independent and composite markers.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 135 dengue patients, 46 (34.1%) had non-severe dengue and 89 (65.9%) had severe dengue. Logistic regression determined prolonged capillary refill time (CRT), lactate \u22652.9 mmol\/L and serum aspartate transaminase (AST) \u2265135 IU\/L as predictive for severe dengue. AUROCs of lactate, AST and combined score incorporating AST, lactate and prolonged CRT for identifying severity were 7.55, 7.23 and 8.5, respectively. The combined score cut-off \u22651 had 87.6% sensitivity, 65.2% specificity, 83% PPV and 73.2% NPV.\u00a0The combined score cut-off \u22653 had 100% specificity and 100% PPV.\u00a0 However, AST &amp;gt;135 IU\/L and lactate &amp;gt;2.9 mmol\/L together had 97.8% specificity and 97.1% PPV for identifying severity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The presence of either \u2018prolonged capillary refill time with one deranged biochemical parameter\u2019 or \u2018both deranged biochemical parameters\u2019 is nearly 100% specific for severity of dengue.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/trstmh\/traa088","type":"journal-article","created":{"date-parts":[[2020,9,4]],"date-time":"2020-09-04T19:14:53Z","timestamp":1599246893000},"page":"838-846","source":"Crossref","is-referenced-by-count":6,"title":["Combined score based on arterial lactate, aspartate transaminase and prolonged capillary refill time is a useful diagnostic criterion for identifying severe dengue"],"prefix":"10.1093","volume":"114","author":[{"given":"Sarika","family":"Gupta","sequence":"first","affiliation":[{"name":"Department of Paediatrics, King George's Medical University, Shah Mina Road, Chowk, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pranaya","family":"Mall","sequence":"additional","affiliation":[{"name":"Department of neonatology, PGIMER, Dr RML Hospital, Presidents\u2019s Estate, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8564-7051","authenticated-orcid":false,"given":"Areesha","family":"Alam","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Era's Lucknow Medical College & Hospital, Sarfarazganj, Hardoi road, Lucknow, Uttar Pradesh, 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