{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T16:55:00Z","timestamp":1782924900318,"version":"3.54.5"},"reference-count":36,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T00:00:00Z","timestamp":1641945600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004515","name":"National University of Malaysia","doi-asserted-by":"publisher","award":["GGPM-2017-110"],"award-info":[{"award-number":["GGPM-2017-110"]}],"id":[{"id":"10.13039\/501100004515","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004515","name":"National University of Malaysia","doi-asserted-by":"publisher","award":["FF-2018-126"],"award-info":[{"award-number":["FF-2018-126"]}],"id":[{"id":"10.13039\/501100004515","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>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. \u201cVomiting\u201d was the commonest WS (62.9%), with shortened clotting time (CT) INTEM (p = 0.01). \u201cHematocrit increase\u201d showed significant prolonged CT INTEM, EXTEM, and FIBTEM (p &lt; 0.05). \u201cPlatelet decrease\u201d showed reduced platelet function and reduced clot amplitude at 10 min (A10) and maximum clot firmness (MCF) in INTEM and EXTEM (p &lt; 0.001). The kinetics were reduced in platelet count, CT EXTEM, and cortisol (p &lt; 0.05) but increased in CT INTEM (p = 0.03). At FP, \u201cvomiting\u201d, \u201chematocrit increase\u201d, and \u201cplatelet decrease\u201d 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, \u201cvomiting\u201d, \u201chematocrit increase\u201d and \u201cplatelet decrease\u201d at FP correlated with ROTEM. No conclusion could be made further regarding ferritin and cortisol. Larger study is required to study \u201chematocrit increase\u201d with ROTEM as a potential marker for hemorrhage.<\/jats:p>","DOI":"10.3390\/ijerph19020807","type":"journal-article","created":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T09:10:36Z","timestamp":1641978636000},"page":"807","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Correlation of Dengue Warning Signs during Febrile Phase with Rotational Thromboelastometry, Cortisol and Feritin"],"prefix":"10.3390","volume":"19","author":[{"given":"Syarifah Syahirah","family":"Syed Abas","sequence":"first","affiliation":[{"name":"Medical Department, Ampang Hospital, Ampang Jaya 68000, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7427-685X","authenticated-orcid":false,"given":"Noralisa","family":"Abdul Karim","sequence":"additional","affiliation":[{"name":"Pusat Terapi Sel, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petrick","family":"Periyasamy","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nurasyikin","family":"Yusof","sequence":"additional","affiliation":[{"name":"Hemostasis & Blood Transfusion Unit, Department of Diagnostic Laboratory Services, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0635-1816","authenticated-orcid":false,"given":"Shamsul Azhar","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Community Health, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tan Toh","family":"Leong","sequence":"additional","affiliation":[{"name":"Emergency Department, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saiful Safuan","family":"Md Sani","sequence":"additional","affiliation":[{"name":"Kuala Lumpur General Hospital, Jalan Pahang, Kuala Lumpur 50586, Federal Territory of Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanita","family":"Othman","sequence":"additional","affiliation":[{"name":"Chemical Pathology Unit, Department of Diagnostic Laboratory Services, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharifah Azura","family":"Salleh","sequence":"additional","affiliation":[{"name":"Infection Control Unit, Department of Medical Microbiology and Immunology, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nurul Nadiah","family":"Mohd Zaidi","sequence":"additional","affiliation":[{"name":"Pusat Terapi Sel, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S Fadilah","family":"Abdul Wahid","sequence":"additional","affiliation":[{"name":"Pusat Terapi Sel, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan Fariza","family":"Wan Jamaludin","sequence":"additional","affiliation":[{"name":"Pusat Terapi Sel, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Federal Territory of Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,12]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2019, February 24). 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