{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:06:59Z","timestamp":1790208419623,"version":"4.1.0"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Res Notes"],"published-print":{"date-parts":[[2012,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>The WHO guidelines were revised recently to identify patients with severe dengue (SD) early. We proceeded to determine the usefulness of the warning signs in the new WHO guidelines in predicting SD and we have also attempted to define other simple laboratory parameters that could be useful in predicting SD.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Clinical and laboratory parameters were recorded in 184 patients in 2011, with confirmed dengue viral infections, admitted to a medical ward in two tertiary care hospitals in Colombo, Sri Lanka.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>We found that the presence of 5 or more dengue warning signs were significantly (p\u2009=\u20090.02) associated with the development of SD (odds ratio 5.14, 95% CI\u2009=\u20091.312 to 20.16). The AST levels were significantly higher (p\u2009=\u20090.0001) in patients with abdominal pain (mean 243.5, SD\u2009\u00b1\u2009200.7), when compared to those who did not have abdominal pain (mean 148.5, SD\u2009\u00b1\u2009218.6). Lymphocyte counts &lt;1,500 cells\/mm<jats:sup>3<\/jats:sup> were significantly (p\u2009=\u20090.005) associated with SD (odds ratio 3.367, 95% CI 1.396 to 8.123). High AST levels were also significantly associated (p\u2009&lt;\u20090.0001) with SD (odds ratio 27.26, 95% CI 1.632 to 455.2). Platelet counts &lt;20,000cells\/mm<jats:sup>3<\/jats:sup>, were again significantly associated (p\u2009&lt;\u20090.001) with severe disease (odds ratio 1.632 to 455.2, 95% CI 3.089 to 14.71). The PCR was positive in 26\/84 of the patients and we found that the infecting serotype was DEN-1 in all 26 patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>The presence of 5 or more warning signs appears to be a predictor of SD. Lymphocyte counts &lt;1,500 cells\/mm<jats:sup>3<\/jats:sup>, platelet counts &lt;20,000\/mm<jats:sup>3<\/jats:sup> and raised AST levels were associated with SD and could be used to help identify patients who are likely to develop SD.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/1756-0500-5-645","type":"journal-article","created":{"date-parts":[[2012,11,20]],"date-time":"2012-11-20T17:28:50Z","timestamp":1353432530000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":55,"title":["Evaluation of the WHO revised criteria for classification of clinical disease severity in acute adult dengue infection"],"prefix":"10.1186","volume":"5","author":[{"given":"SD","family":"Jayaratne","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vajini","family":"Atukorale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laksiri","family":"Gomes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thashi","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tharindu","family":"Wijesinghe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sachie","family":"Fernando","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham S","family":"Ogg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gathsaurie Neelika","family":"Malavige","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2012,11,20]]},"reference":[{"key":"1935_CR1","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1038\/448734a","volume":"448","author":"E Callaway","year":"2007","unstructured":"Callaway E: Dengue fever climbs the social ladder. Nature. 2007, 448: 734-735.","journal-title":"Nature"},{"issue":"948","key":"1935_CR2","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1136\/pgmj.2004.019638","volume":"80","author":"GN Malavige","year":"2004","unstructured":"Malavige GN, Fernando S, Fernando DJ, Seneviratne SL: Dengue viral infections. Postgrad med j. 2004, 80 (948): 588-601. 10.1136\/pgmj.2004.019638.","journal-title":"Postgrad med j"},{"key":"1935_CR3","unstructured":"Comprehensive guidelines for prevention and control of dengue fever and dengue haemorrhagic fever: 2011, Geneva, Switzerland: World Health Organization"},{"issue":"4","key":"1935_CR4","first-page":"129","volume":"11","author":"DR Munasinghe","year":"1966","unstructured":"Munasinghe DR, Amarasekera PJ, Fernando CF: An epidemic of dengue-like fever in Ceylon (chikungunya\u2013a clinical and haematological study. Ceylon med j. 1966, 11 (4): 129-142.","journal-title":"Ceylon med j"},{"issue":"2","key":"1935_CR5","first-page":"67","volume":"12","author":"NM Mendis","year":"1967","unstructured":"Mendis NM: Epidemiology of dengue-like fever in ceylon. Ceylon med j. 1967, 12 (2): 67-74.","journal-title":"Ceylon med j"},{"issue":"1","key":"1935_CR6","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1002\/jmv.2190","volume":"67","author":"SJ Gagnon","year":"2002","unstructured":"Gagnon SJ, Mori M, Kurane I, Green S, Vaughn DW, Kalayanarooj S, Suntayakorn S, Ennis FA, Rothman AL: Cytokine gene expression and protein production in peripheral blood mononuclear cells of children with acute dengue virus infections. J Med Virol. 2002, 67 (1): 41-46. 10.1002\/jmv.2190.","journal-title":"J Med Virol"},{"key":"1935_CR7","unstructured":"Dengue in Sri Lanka: Epidemiology unit, Sri Lanka,http:\/\/www.epid.gov.lk\/Dengue_updates.htm,"},{"key":"1935_CR8","volume-title":"Dengue guildelines for diagnosis, prevention and control, New edition edn","author":"WHO","year":"2009","unstructured":"WHO: Dengue guildelines for diagnosis, prevention and control, New edition edn. 2009, Geneva, Switzerland: World Health Organisation"},{"issue":"4","key":"1935_CR9","first-page":"343","volume":"20","author":"A Santiago","year":"2001","unstructured":"Santiago A, Fernandez-Sein A: Dengue in children: critical points in management. P R Heal Sci J. 2001, 20 (4): 343-346.","journal-title":"P R Heal Sci J"},{"issue":"2 Suppl","key":"1935_CR10","doi-asserted-by":"publisher","first-page":"S22","DOI":"10.1590\/S0021-75572007000300004","volume":"83","author":"S Singhi","year":"2007","unstructured":"Singhi S, Kissoon N, Bansal A: Dengue and dengue hemorrhagic fever: management issues in an intensive care unit. J Pediatr. 2007, 83 (2 Suppl): S22-S35.","journal-title":"J Pediatr"},{"issue":"9530","key":"1935_CR11","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1016\/S0140-6736(06)69006-5","volume":"368","author":"JL Deen","year":"2006","unstructured":"Deen JL, Harris E, Wills B, Balmaseda A, Hammond SN, Rocha C, Dung NM, Hung NT, Hien TT, Farrar JJ: The WHO dengue classification and case definitions: time for a reassessment. Lancet. 2006, 368 (9530): 170-173. 10.1016\/S0140-6736(06)69006-5.","journal-title":"Lancet"},{"issue":"8","key":"1935_CR12","doi-asserted-by":"publisher","first-page":"1238","DOI":"10.1111\/j.1365-3156.2006.01678.x","volume":"11","author":"S Bandyopadhyay","year":"2006","unstructured":"Bandyopadhyay S, Lum LC, Kroeger A: Classifying dengue: a review of the difficulties in using the WHO case classification for dengue haemorrhagic fever. Trop Med Int Health. 2006, 11 (8): 1238-1255. 10.1111\/j.1365-3156.2006.01678.x.","journal-title":"Trop Med Int Health"},{"key":"1935_CR13","volume-title":"Trop Med Int Health","author":"N Alexander","year":"2011","unstructured":"Alexander N, Balmaseda A, Coelho IC, Dimaano E, Hien TT, Hung NT, Janisch T, Kroeger A, Lum LC, Martinez E: Multicentre prospective study on dengue classification in four South-east Asian and three Latin American countries. Trop Med Int Health. 2011"},{"key":"1935_CR14","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1186\/1471-2334-11-106","volume":"11","author":"J Barniol","year":"2011","unstructured":"Barniol J, Gaczkowski R, Barbato EV, da Cunha RV, Salgado D, Martinez E, Segarra CS, Pleites Sandoval EB, Mishra A, Laksono IS: Usefulness and applicability of the revised dengue case classification by disease: multi-centre study in 18 countries. BMC Infect Dis. 2011, 11: 106-118. 10.1186\/1471-2334-11-106.","journal-title":"BMC Infect Dis"},{"issue":"11","key":"1935_CR15","doi-asserted-by":"publisher","first-page":"e1397","DOI":"10.1371\/journal.pntd.0001397","volume":"5","author":"F Narvaez","year":"2011","unstructured":"Narvaez F, Gutierrez G, Perez MA, Elizondo D, Nunez A, Balmaseda A, Harris E: Evaluation of the traditional and revised WHO classifications of Dengue disease severity. PLoS Negl Trop Dis. 2011, 5 (11): e1397-10.1371\/journal.pntd.0001397.","journal-title":"PLoS Negl Trop Dis"},{"issue":"4","key":"1935_CR16","doi-asserted-by":"crossref","first-page":"693","DOI":"10.4269\/ajtmh.1999.60.693","volume":"60","author":"DW Vaughn","year":"1999","unstructured":"Vaughn DW, Nisalak A, Solomon T, Kalayanarooj S, Nguyen MD, Kneen R, Cuzzubbo A, Devine PL: Rapid serologic diagnosis of dengue virus infection using a commercial capture ELISA that distinguishes primary and secondary infections. AmJTrop Med Hyg. 1999, 60 (4): 693-698.","journal-title":"AmJTrop Med Hyg"},{"issue":"1","key":"1935_CR17","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1128\/CDLI.5.1.7-10.1998","volume":"5","author":"CT Sang","year":"1998","unstructured":"Sang CT, Cuzzubbo AJ, Devine PL: Evaluation of a commercial capture enzyme-linked immunosorbent assay for detection of immunoglobulin M and G antibodies produced during dengue infection. Clin Diagn Lab Immunol. 1998, 5 (1): 7-10.","journal-title":"Clin Diagn Lab Immunol"},{"issue":"3","key":"1935_CR18","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1128\/jcm.30.3.545-551.1992","volume":"30","author":"RS Lanciotti","year":"1992","unstructured":"Lanciotti RS, Calisher CH, Gubler DJ, Chang GJ, Vorndam AV: Rapid detection and typing of dengue viruses from clinical samples by using reverse transcriptase-polymerase chain reaction. J Clin Microbiol. 1992, 30 (3): 545-551.","journal-title":"J Clin Microbiol"},{"key":"1935_CR19","volume-title":"WHO Regional publication, SEARO","author":"Prevention and control of dengue and dengue haemorrhagic fever: comprehensive guidelines","year":"1999","unstructured":"Prevention and control of dengue and dengue haemorrhagic fever: comprehensive guidelines: WHO Regional publication, SEARO. 1999, Geneva, Switzerland: World Health Organisation, vol. 29","edition":"vol. 29"},{"issue":"8","key":"1935_CR20","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1111\/j.1365-3156.2012.03020.x","volume":"17","author":"RW Wieten","year":"2012","unstructured":"Wieten RW, Vlietstra W, Goorhuis A, van Vugt M, Hodiamont CJ, Leenstra T, de Vries PJ, Janssen S, van Thiel PP, Stijnis K: Dengue in travellers: applicability of the 1975\u20131997 and the 2009 WHO classification system of dengue fever. Trop Med Int Health. 2012, 17 (8): 1023-1030. 10.1111\/j.1365-3156.2012.03020.x.","journal-title":"Trop Med Int Health"},{"key":"1935_CR21","doi-asserted-by":"crossref","unstructured":"Zaki SA, Shanbag P: Clinical manifestations of dengue and leptospirosis in children in Mumbai: an observational study. Infection. 38 (4): 285-291.","DOI":"10.1007\/s15010-010-0030-3"},{"issue":"5","key":"1935_CR22","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1093\/qjmed\/hcl039","volume":"99","author":"GN Malavige","year":"2006","unstructured":"Malavige GN, Velathanthiri VG, Wijewickrama ES, Fernando S, Jayaratne SD, Aaskov J, Seneviratne SL: Patterns of disease among adults hospitalized with dengue infections. QJM. 2006, 99 (5): 299-305. 10.1093\/qjmed\/hcl039.","journal-title":"QJM"},{"key":"1935_CR23","doi-asserted-by":"crossref","unstructured":"Giraldo D, Sant\u2019Anna C, Perisse AR, March Mde F, Souza AP, Mendes A, Bonfim M, Hofer CB: Characteristics of children hospitalized with dengue fever in an outbreak in Rio de janeiro, brazil. Trans Royal Soc Trop Med Hyg. 105 (10): 601-603.","DOI":"10.1016\/j.trstmh.2011.07.007"},{"key":"1935_CR24","doi-asserted-by":"crossref","unstructured":"Thomas L, Brouste Y, Najioullah F, Hochedez P, Hatchuel Y, Moravie V, Kaidomar S, Besnier F, Abel S, Rosine J: Predictors of severe manifestations in a cohort of adult dengue patients. J Clin Virol. 48 (2): 96-99.","DOI":"10.1016\/j.jcv.2010.03.008"},{"issue":"1","key":"1935_CR25","first-page":"166","volume":"86","author":"van de Weg CA, van Gorp EC, Supriatna M, Soemantri A, Osterhaus AD, Martina BE: Evaluation of the","year":"2009","unstructured":"van de Weg CA, van Gorp EC, Supriatna M, Soemantri A, Osterhaus AD, Martina BE: Evaluation of the: WHO dengue case classification in an indonesian pediatric cohort. AmJTrop Med Hyg. 2009, 86 (1): 166-170.","journal-title":"AmJTrop Med Hyg"},{"issue":"Suppl 3","key":"1935_CR26","first-page":"S74","volume":"94","author":"S Kalayanarooj","year":"2011","unstructured":"Kalayanarooj S: Dengue classification: current WHO vs. the newly suggested classification for better clinical application?. J Med Assoc Thailand Chotmaihet thangphaet. 2011, 94 (Suppl 3): S74-84.","journal-title":"J Med Assoc Thailand Chotmaihet thangphaet"},{"issue":"2","key":"1935_CR27","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1179\/2047773212Y.0000000017","volume":"106","author":"O Horstick","year":"2012","unstructured":"Horstick O, Farrar J, Lum L, Martinez E, San Martin JL, Ehrenberg J, Velayudhan R, Kroeger A: Reviewing the development, evidence base, and application of the revised dengue case classification. Pathog global health. 2012, 106 (2): 94-101.","journal-title":"Pathog global health"},{"key":"1935_CR28","doi-asserted-by":"crossref","unstructured":"Gupta V, Yadav TP, Pandey RM, Singh A, Gupta M, Kanaujiya P, Sharma A, Dewan V: Risk factors of dengue shock syndrome in children. J Trop Pediatr. 57 (6): 451-456.","DOI":"10.1093\/tropej\/fmr020"},{"key":"1935_CR29","doi-asserted-by":"crossref","unstructured":"Low JG, Ong A, Tan LK, Chaterji S, Chow A, Lim WY, Lee KW, Chua R, Chua CR, Tan SW: The early clinical features of dengue in adults: challenges for early clinical diagnosis. PLoS Negl Trop Dis. 5 (5): e1191-","DOI":"10.1371\/journal.pntd.0001191"},{"issue":"2","key":"1935_CR30","doi-asserted-by":"publisher","first-page":"143","DOI":"10.4103\/0255-0857.32722","volume":"25","author":"GN Malavige","year":"2007","unstructured":"Malavige GN, Ranatunga PK, Jayaratne SD, Wijesiriwardana B, Seneviratne SL, Karunatilaka DH: Dengue viral infections as a cause of encephalopathy. Indian j med microbiol. 2007, 25 (2): 143-145. 10.4103\/0255-0857.32722.","journal-title":"Indian j med microbiol"},{"issue":"4","key":"1935_CR31","doi-asserted-by":"publisher","first-page":"774","DOI":"10.4269\/ajtmh.2010.10-0090","volume":"83","author":"DT Trung","year":"2010","unstructured":"Trung DT, le Thao TT, Hien TT, Hung NT, Vinh NN, Hien PT, Chinh NT, Simmons C, Wills B: Liver involvement associated with dengue infection in adults in Vietnam. AmJTrop Med Hyg. 2010, 83 (4): 774-780. 10.4269\/ajtmh.2010.10-0090.","journal-title":"AmJTrop Med Hyg"},{"issue":"7","key":"1935_CR32","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1016\/j.trstmh.2005.10.007","volume":"100","author":"SL Seneviratne","year":"2006","unstructured":"Seneviratne SL, Malavige GN, de Silva HJ: Pathogenesis of liver involvement during dengue viral infections. Trans Royal Soc Trop Med Hyg. 2006, 100 (7): 608-614. 10.1016\/j.trstmh.2005.10.007.","journal-title":"Trans Royal Soc Trop Med Hyg"},{"issue":"1","key":"1935_CR33","first-page":"47","volume":"40","author":"V Chongsrisawat","year":"2009","unstructured":"Chongsrisawat V, Hutagalung Y, Poovorawan Y: Liver function test results and outcomes in children with acute liver failure due to dengue infection. Southeast Asian j trop med public health. 2009, 40 (1): 47-53.","journal-title":"Southeast Asian j trop med public health"},{"issue":"4","key":"1935_CR34","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1097\/01.pdm.0000213462.60645.cd","volume":"15","author":"FC de Macedo","year":"2006","unstructured":"de Macedo FC, Nicol AF, Cooper LD, Yearsley M, Pires AR, Nuovo GJ: Histologic, viral, and molecular correlates of dengue fever infection of the liver using highly sensitive immunohistochemistry. Diagn mol pathol: Am j surg pathol, part B. 2006, 15 (4): 223-228. 10.1097\/01.pdm.0000213462.60645.cd.","journal-title":"Diagn mol pathol: Am j surg pathol, part B"},{"issue":"8","key":"1935_CR35","doi-asserted-by":"publisher","first-page":"e769","DOI":"10.1371\/journal.pntd.0000769","volume":"4","author":"JA Potts","year":"2010","unstructured":"Potts JA, Gibbons RV, Rothman AL, Srikiatkhachorn A, Thomas SJ, Supradish PO, Lemon SC, Libraty DH, Green S, Kalayanarooj S: Prediction of dengue disease severity among pediatric Thai patients using early clinical laboratory indicators. PLoS Negl Trop Dis. 2010, 4 (8): e769-10.1371\/journal.pntd.0000769.","journal-title":"PLoS Negl Trop Dis"},{"issue":"2","key":"1935_CR36","doi-asserted-by":"publisher","first-page":"192","DOI":"10.3201\/eid1502.080926","volume":"15","author":"N Kanakaratne","year":"2009","unstructured":"Kanakaratne N, Wahala WM, Messer WB, Tissera HA, Shahani A, Abeysinghe N, De-Silva AM, Gunasekera M: Severe dengue epidemics in Sri Lanka, 2003\u20132006. Emerg Infect Dis. 2009, 15 (2): 192-199. 10.3201\/eid1502.080926.","journal-title":"Emerg Infect Dis"}],"container-title":["BMC Research Notes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/1756-0500-5-645.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T21:16:23Z","timestamp":1630530983000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcresnotes.biomedcentral.com\/articles\/10.1186\/1756-0500-5-645"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,11,20]]},"references-count":36,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2012,12]]}},"alternative-id":["1935"],"URL":"https:\/\/doi.org\/10.1186\/1756-0500-5-645","relation":{},"ISSN":["1756-0500"],"issn-type":[{"value":"1756-0500","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,11,20]]},"assertion":[{"value":"1 August 2012","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 November 2012","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 November 2012","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}],"article-number":"645"}}