{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T17:25:17Z","timestamp":1780334717092,"version":"3.54.1"},"update-to":[{"DOI":"10.12688\/f1000research.132714.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,12,18]],"date-time":"2023-12-18T00:00:00Z","timestamp":1702857600000}}],"reference-count":18,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2023,12,18]],"date-time":"2023-12-18T00:00:00Z","timestamp":1702857600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns7:p>Background Capillary leak is the hallmark of development of severe dengue. A rise in haematocrit has been a major warning sign in WHO guidelines. Postural hypotension, which could reflect the intravascular volume reduction in capillary leak has been noted as warning sign in CDC and Pan American Health Organisation guidelines. We evaluated the diagnostic accuracy of postural hypotension as a marker of development of severe dengue. Methods 150 patients admitted with dengue fever were recruited in this prospective observational study. Diagnostic accuracy of conventional warning signs (abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, liver enlargement, increasing hematocrit with decreasing platelets) and postural hypotension was evaluated. Results 23 (15.3%) subjects developed severe dengue. Multiple logistic regression analysis showed that ascites\/pleural effusion and postural fall in systolic blood pressure of &gt;10.33% had odds ratio of 5.024(95%CI:1.11 \u2013 22.75) and 11.369 (95% CI:2.27 \u2013 56.87), respectively. Other parameters did not reach statistical significance. Sensitivity and specificity of ascites\/pleural effusion were 82.6% and 88.2% for development of severe dengue whereas postural fall in systolic blood pressure had sensitivity and specificity of 87% and 82.7%. Conclusions These findings present a strong case for including postural hypotension as a warning sign in patients with dengue fever, especially in resource limited settings.<\/ns7:p>","DOI":"10.12688\/f1000research.132714.2","type":"journal-article","created":{"date-parts":[[2023,12,18]],"date-time":"2023-12-18T06:30:05Z","timestamp":1702881005000},"page":"816","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Postural fall in systolic blood pressure is a useful warning sign in dengue fever"],"prefix":"10.12688","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0460-7913","authenticated-orcid":false,"given":"Chakrapani","family":"Mahabala","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4513-0215","authenticated-orcid":false,"given":"Archith","family":"Boloor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sushmita","family":"Upadhya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satya Sudish","family":"Nimmagadda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9231-671X","authenticated-orcid":false,"given":"Tejaswini","family":"Lakshmikeshava","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6770-1715","authenticated-orcid":false,"given":"Raghav","family":"Anand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2023,12,18]]},"reference":[{"key":"ref1","article-title":"Directorate General of Health Services MoHaFW G of I 2022. Dengue cases and deaths in the country since 2015.","year":"cited 2023 Feb 12"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph15092018","article-title":"The sensitivity, specificity and accuracy of warning signs in predicting severe dengue, the severe dengue prevalence and its associated factors.","volume":"15","author":"M Ahmad","year":"2018 Sep 15","journal-title":"Int. J. Environ. Res. Public Health."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"396-404","DOI":"10.1080\/23744235.2020.1749723","article-title":"The spectrum of disease severity, the burden of hospitalizations and associated risk factors in confirmed dengue among persons of all ages: findings from a population based longitudinal study from Barbados.","volume":"52","author":"A Kumar","year":"2020","journal-title":"Infect. Dis."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"350-363","DOI":"10.1016\/S0140-6736(18)32560-1","article-title":"Dengue.","volume":"393","author":"A Wilder-Smith","year":"2019 Jan 26","journal-title":"Lancet."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1014-1026","DOI":"10.1016\/S1473-3099(20)30601-0","article-title":"Risk predictors of progression to severe disease during the febrile phase of dengue: a systematic review and meta-analysis.","volume":"21","author":"S Sangkaew","year":"2021 Jul 1","journal-title":"Lancet Infect. Dis."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e0267186","DOI":"10.1371\/journal.pone.0267186","article-title":"Risk and predictive factors for severe dengue infection: A systematic review and metaanalysis.","volume":"17","author":"K Yuan","year":"2022 Apr 1","journal-title":"PLoS One."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"93-98","DOI":"10.1590\/0074-0276140384","article-title":"Evaluation of the WHO classification of dengue disease severity during an epidemic in 2011 in the state of Cear\u00e1, Brazil.","volume":"109","author":"L Cavalcanti","year":"2014 Feb","journal-title":"Mem. Inst. Oswaldo Cruz."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.1186\/s12879-021-06793-2","article-title":"Plasma leakage in dengue: a systematic review of prospective observational studies.","volume":"21","author":"C Rodrigo","year":"2021 Dec 1","journal-title":"BMC Infect. Dis."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"94-101","DOI":"10.1179\/2047773212Y.0000000017","article-title":"Reviewing the development, evidence base, and application of the revised dengue case classification.","volume":"106","author":"O Horstick","year":"2012 May","journal-title":"Pathog. Glob. Health."},{"key":"ref10","doi-asserted-by":"crossref","DOI":"10.3855\/jidc.708","article-title":"Assessment of World Health Organization definition of dengue hemorrhagic fever in North India.","author":"P Gupta","year":"2010"},{"key":"ref14","article-title":"Regional Arboviral Disease Program Algorithms for the Clinical Management of Dengue Patients.","year":"2020"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"S79-S88","DOI":"10.1093\/infdis\/jiw609","article-title":"Case management of dengue: Lessons learned.","volume":"215","author":"S Kalayanarooj","year":"2017","journal-title":"J. Infect. Dis."},{"key":"ref16","first-page":"71-73","article-title":"Atypical Manifestations of Dengue Fever (DF) - Where Do We Stand Today?","volume":"8","author":"S Sudhish Nimmagadda","year":"2014 Jan 12 cited 2023 Feb 12","journal-title":"J. Clin. Diagn. Res."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"479-484","DOI":"10.1007\/s12291-013-0386-0","article-title":"When is a south Indian really anemic?","volume":"29","author":"D Pasupula","year":"2014 Oct 1","journal-title":"Indian J. Clin. Biochem."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1154-1159","DOI":"10.1111\/j.1365-3156.2009.02337.x","article-title":"Decision tree algorithm in deciding hospitalization for adult patients with dengue haemorrhagic fever in Singapore.","volume":"14","author":"V Lee","year":"2009 Sep","journal-title":"Trop. Med. Int. Health."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e0161696","DOI":"10.1371\/journal.pone.0161696","article-title":"Proposal of a Clinical Decision Tree Algorithm Using Factors Associated with Severe Dengue Infection.","volume":"11","author":"J Tamibmaniam","year":"2016 Aug 1 cited 2023 Feb 12","journal-title":"PLoS One."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1186\/s12887-018-1078-y","article-title":"Predicting the severity of dengue fever in children on admission based on clinical features and laboratory indicators: application of classification tree analysis.","volume":"18","author":"K Phakhounthong","year":"2018 Mar 13 cited 2023 Feb 12","journal-title":"BMC Pediatr."},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.5061\/dryad.jwstqjqfc","article-title":"Postural fall in Systolic Blood Pressure is an useful warning sign in Dengue Fever.","author":"C Mahabala","journal-title":"Dryad."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/12-816\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/12-816\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/12-816\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,2]],"date-time":"2024-01-02T23:40:11Z","timestamp":1704238811000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/12-816\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,18]]},"references-count":18,"URL":"https:\/\/doi.org\/10.12688\/f1000research.132714.2","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.159870.r231031","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.159870.r231032","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.159870.r231032","asserted-by":"object"},{"id-type":"doi","id":"10.5256\/f1000research.159870.r231031","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,18]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/12-816\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.159870.r231032, Soumya Pahari, Nepalese Army Institute of Health Sciences (NAIHS), Sanobharyang, 03 Jan 2024, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/12-816\/v2#referee-response-231032","order":0,"name":"referee-response-231032","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.159870.r231031, Rivaldo Steven Heriyanto, Pelita Harapan University, Tangerang, 23 Dec 2023, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/12-816\/v2#referee-response-231031","order":1,"name":"referee-response-231031","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":2,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}