{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T23:24:22Z","timestamp":1782861862675,"version":"3.54.5"},"reference-count":34,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,3,25]],"date-time":"2023-03-25T00:00:00Z","timestamp":1679702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Health Research Institute (NHRI), Taiwan","award":["NHRI-106A1-MRCO-0517178"],"award-info":[{"award-number":["NHRI-106A1-MRCO-0517178"]}]},{"name":"National Health Research Institute (NHRI), Taiwan","award":["MR-106-PP-01"],"award-info":[{"award-number":["MR-106-PP-01"]}]},{"name":"National Health Research Institute (NHRI), Taiwan","award":["MOST 111-2625-M-006-016"],"award-info":[{"award-number":["MOST 111-2625-M-006-016"]}]},{"name":"National Health Research Institute (NHRI), Taiwan","award":["NCKUH-10506016"],"award-info":[{"award-number":["NCKUH-10506016"]}]},{"name":"National Health Research Institute (NHRI), Taiwan","award":["NCKUH-11203011"],"award-info":[{"award-number":["NCKUH-11203011"]}]},{"name":"National Science and Technology Council","award":["NHRI-106A1-MRCO-0517178"],"award-info":[{"award-number":["NHRI-106A1-MRCO-0517178"]}]},{"name":"National Science and Technology Council","award":["MR-106-PP-01"],"award-info":[{"award-number":["MR-106-PP-01"]}]},{"name":"National Science and Technology Council","award":["MOST 111-2625-M-006-016"],"award-info":[{"award-number":["MOST 111-2625-M-006-016"]}]},{"name":"National Science and Technology Council","award":["NCKUH-10506016"],"award-info":[{"award-number":["NCKUH-10506016"]}]},{"name":"National Science and Technology Council","award":["NCKUH-11203011"],"award-info":[{"award-number":["NCKUH-11203011"]}]},{"DOI":"10.13039\/501100004844","name":"Research Centre of National Cheng Kung University Hospital","doi-asserted-by":"publisher","award":["NHRI-106A1-MRCO-0517178"],"award-info":[{"award-number":["NHRI-106A1-MRCO-0517178"]}],"id":[{"id":"10.13039\/501100004844","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004844","name":"Research Centre of National Cheng Kung University Hospital","doi-asserted-by":"publisher","award":["MR-106-PP-01"],"award-info":[{"award-number":["MR-106-PP-01"]}],"id":[{"id":"10.13039\/501100004844","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004844","name":"Research Centre of National Cheng Kung University Hospital","doi-asserted-by":"publisher","award":["MOST 111-2625-M-006-016"],"award-info":[{"award-number":["MOST 111-2625-M-006-016"]}],"id":[{"id":"10.13039\/501100004844","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004844","name":"Research Centre of National Cheng Kung University Hospital","doi-asserted-by":"publisher","award":["NCKUH-10506016"],"award-info":[{"award-number":["NCKUH-10506016"]}],"id":[{"id":"10.13039\/501100004844","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004844","name":"Research Centre of National Cheng Kung University Hospital","doi-asserted-by":"publisher","award":["NCKUH-11203011"],"award-info":[{"award-number":["NCKUH-11203011"]}],"id":[{"id":"10.13039\/501100004844","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Global travel and climate change have drastically increased the number of countries with endemic or epidemic dengue. The largest dengue outbreak in Taiwan, with 43,419 cases and 228 deaths, occurred in 2015. Practical and cost-effective tools for early prediction of clinical outcomes in dengue patients, especially the elderly, are limited. This study identified the clinical profile and prognostic indicators of critical outcomes in dengue patients on the basis of clinical parameters and comorbidities. A retrospective cross-sectional study was conducted in a tertiary hospital from 1 July 2015 to 30 November 2015. Patients diagnosed with dengue were enrolled, and the initial clinical presentations, diagnostic laboratory data, details of the underlying comorbidities, and initial management recommendations based on 2009 World Health Organization (WHO) guidelines were used to evaluate prognostic indicators of critical outcomes in dengue patients. Dengue patients from another regional hospital were used to evaluate accuracy. A group B (4 points) classification, temperature &lt; 38.5 \u00b0C (1 point), lower diastolic blood pressure (1 point), prolonged activated partial thromboplastin time (aPTT) (2 points), and elevated liver enzymes (1 point) were included in the scoring system. The area under the receiver operating characteristic curve of the clinical model was 0.933 (95% confidence interval [CI]: 0.905\u20130.960). The tool had good predictive value and clinical applicability for identifying patients with critical outcomes.<\/jats:p>","DOI":"10.3390\/tropicalmed8040188","type":"journal-article","created":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T02:18:27Z","timestamp":1679883507000},"page":"188","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Development and Utility of Practical Indicators of Critical Outcomes in Dengue Patients Presenting to Hospital: A Retrospective Cross-Sectional Study"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4481-3102","authenticated-orcid":false,"given":"Chia-Yu","family":"Chi","sequence":"first","affiliation":[{"name":"National Mosquito-Borne Diseases Control Research Center, National Health Research Institutes, Miaoli County 35053, Taiwan"},{"name":"National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County 35053, Taiwan"},{"name":"Department of Microbiology & Immunology, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0012-9026","authenticated-orcid":false,"given":"Tzu-Ching","family":"Sung","sequence":"additional","affiliation":[{"name":"School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung 840203, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6447-8703","authenticated-orcid":false,"given":"Ko","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan"},{"name":"Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 81267, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Wen","family":"Chien","sequence":"additional","affiliation":[{"name":"Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan"},{"name":"School of Medicine, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4350-6701","authenticated-orcid":false,"given":"Hsiang-Chin","family":"Hsu","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan"},{"name":"Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan"},{"name":"Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9498-6178","authenticated-orcid":false,"given":"Yi-Fang","family":"Tu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan"},{"name":"Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Ting","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsin-I","family":"Shih","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan"},{"name":"Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan"},{"name":"Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Brady, O.J., Gething, P.W., Bhatt, S., Messina, J.P., Brownstein, J.S., Hoen, A.G., Moyes, C.L., Farlow, A.W., Scott, T.W., and Hay, S.I. (2012). Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl. Trop. Dis., 6.","DOI":"10.1371\/journal.pntd.0001760"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1038\/nrmicro2460","article-title":"Dengue: A continuing global threat","volume":"8","author":"Guzman","year":"2010","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_3","first-page":"121","article-title":"Clinical characteristics of dengue and dengue hemorrhagic fever in a medical center of southern Taiwan during the 2002 epidemic","volume":"39","author":"Lee","year":"2006","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_4","unstructured":"(2020, August 15). CDC Annual Report 2016, Available online: https:\/\/www.cdc.gov.tw\/InfectionReport\/Info\/MBykt7DHDDcSbrcfxoLRoQ?infoId=HCzh6FgAgovrYiZVrpJrbw."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.ijid.2016.11.008","article-title":"Trend and geographic analysis of the prevalence of dengue in Taiwan, 2010-2015","volume":"54","author":"Hsu","year":"2017","journal-title":"Int. J. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Mohd-Zaki, A.H., Brett, J., Ismail, E., and L\u2019Azou, M. (2014). Epidemiology of dengue disease in Malaysia (2000\u20132012): A systematic literature review. PLoS Negl. Trop. Dis., 8.","DOI":"10.1371\/journal.pntd.0003159"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Bravo, L., Roque, V.G., Brett, J., Dizon, R., and L\u2019Azou, M. (2014). Epidemiology of dengue disease in the Philippines (2000\u20132011): A systematic literature review. PLoS Negl. Trop. Dis., 8.","DOI":"10.1371\/journal.pntd.0003027"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"127","DOI":"10.4269\/ajtmh.2011.10-0476","article-title":"Epidemiological factors associated with dengue shock syndrome and mortality in hospitalized dengue patients in Ho Chi Minh City, Vietnam","volume":"84","author":"Anders","year":"2011","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1016\/S0140-6736(97)12483-7","article-title":"Dengue and dengue haemorrhagic fever","volume":"352","author":"Clark","year":"1998","journal-title":"Lancet"},{"key":"ref_10","unstructured":"World Health Organization (2020, August 15). Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control: New Edition, Available online: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23762963."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Pang, J., Thein, T.L., Leo, Y.S., and Lye, D.C. (2014). Early clinical and laboratory risk factors of intensive care unit requirement during 2004-2008 dengue epidemics in Singapore: A matched case-control study. BMC Infect. Dis., 14.","DOI":"10.1186\/s12879-014-0649-2"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Low, J.G., Ong, A., Tan, L.K., Chaterji, S., Chow, A., Lim, W.Y., Lee, K.W., Chua, R., Chua, C.R., and Tan, S.W. (2011). The early clinical features of dengue in adults: Challenges for early clinical diagnosis. PLoS Negl. Trop. Dis., 5.","DOI":"10.1371\/journal.pntd.0001191"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1097\/MCC.0000000000000339","article-title":"Critical care for dengue in adult patients: An overview of current knowledge and future challenges","volume":"22","author":"Pang","year":"2016","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Liew, S.M., Khoo, E.M., Ho, B.K., Lee, Y.K., Omar, M., Ayadurai, V., Mohamed Yusoff, F., Suli, Z., Mudin, R.N., and Goh, P.P. (2016). Dengue in Malaysia: Factors Associated with Dengue Mortality from a National Registry. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0157631"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Pinto, R.C., Castro, D.B., Albuquerque, B.C., Sampaio Vde, S., Passos, R.A., Costa, C.F., Sadahiro, M., and Braga, J.U. (2016). Mortality Predictors in Patients with Severe Dengue in the State of Amazonas, Brazil. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0161884"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Thein, T.L., Leo, Y.S., Fisher, D.A., Low, J.G., Oh, H.M., Gan, V.C., Wong, J.G., and Lye, D.C. (2013). Risk factors for fatality among confirmed adult dengue inpatients in Singapore: A matched case-control study. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0081060"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1128\/CMR.11.3.480","article-title":"Dengue and dengue hemorrhagic fever","volume":"11","author":"Gubler","year":"1998","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/S1473-3099(01)00171-2","article-title":"Dengue: An update","volume":"2","author":"Guzman","year":"2002","journal-title":"Lancet. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1158\/1055-9965.EPI-19-1214","article-title":"Risk of Leukemia after Dengue Virus Infection: A Population-Based Cohort Study","volume":"29","author":"Chien","year":"2020","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Yeh, C.Y., Chen, P.L., Chuang, K.T., Shu, Y.C., Chien, Y.W., Perng, G.C., Ko, W.C., and Ko, N.Y. (2017). Symptoms associated with adverse dengue fever prognoses at the time of reporting in the 2015 dengue outbreak in Taiwan. PLoS Negl. Trop. Dis., 11.","DOI":"10.1371\/journal.pntd.0006091"},{"key":"ref_21","unstructured":"Diagnostics, S. (2016, July 20). SD BIOLINE Dengue Duo. Available online: https:\/\/www.globalpointofcare.abbott\/en\/product-details\/sd-bioline-dengue-duo-ns1-ag---ab-combo.html."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Hsieh, C.C., Cia, C.T., Lee, J.C., Sung, J.M., Lee, N.Y., Chen, P.L., Kuo, T.H., Chao, J.Y., and Ko, W.C. (2017). A Cohort Study of Adult Patients with Severe Dengue in Taiwanese Intensive Care Units: The Elderly and APTT Prolongation Matter for Prognosis. PLoS Negl. Trop. Dis., 11.","DOI":"10.1371\/journal.pntd.0005270"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"845876","DOI":"10.1155\/2013\/845876","article-title":"Development of dengue infection severity score","volume":"2013","author":"Pongpan","year":"2013","journal-title":"ISRN Pediatr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"111","DOI":"10.23937\/2474-3658\/1510111","article-title":"Predictors of Dengue Shock Syndrome: APTT Elevation as a Risk Factor in Children with Dengue Fever","volume":"6","author":"Vijayaraghavan","year":"2020","journal-title":"J. Infect. Dis. Epidemiol."},{"key":"ref_25","first-page":"67","article-title":"Significance of APTT as early predictor of bleeding in comparison to thrombocytopenia in dengue virus infection","volume":"7","author":"Hamsa","year":"2019","journal-title":"Int. J. Res. Med. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1016\/j.jmii.2016.08.024","article-title":"Analyses of clinical and laboratory characteristics of dengue adults at their hospital presentations based on the World Health Organization clinical-phase framework: Emphasizing risk of severe dengue in the elderly","volume":"51","author":"Kuo","year":"2018","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_27","first-page":"e180082","article-title":"Comorbidities increase in-hospital mortality in dengue patients in Brazil","volume":"113","author":"Werneck","year":"2018","journal-title":"Mem. Do Inst. Oswaldo Cruz"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1014","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":"Sangkaew","year":"2021","journal-title":"Lancet. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1080\/10543400903572894","article-title":"A Review of: \u201cROC Curves for Continuous Data, by W. J. Krzanowski and D. J. Hand\u201d","volume":"20","year":"2010","journal-title":"J. Biopharm. Stat."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Chien, Y.W., Chuang, H.N., Wang, Y.P., Perng, G.C., Chi, C.Y., and Shih, H.I. (2022). Short-term, medium-term, and long-term risks of nonvariceal upper gastrointestinal bleeding after dengue virus infection. PLoS Negl. Trop. Dis., 16.","DOI":"10.1371\/journal.pntd.0010039"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Chien, Y.W., Huang, H.M., Ho, T.C., Tseng, F.C., Ko, N.Y., Ko, W.C., and Perng, G.C. (2019). Seroepidemiology of dengue virus infection among adults during the ending phase of a severe dengue epidemic in southern Taiwan, 2015. BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-3946-y"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.jiph.2019.07.012","article-title":"Diagnosis of severe dengue: Challenges, needs and opportunities","volume":"13","author":"Wong","year":"2020","journal-title":"J. Infect. Public Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1093\/trstmh\/try135","article-title":"Comparison of clinical tools for dengue diagnosis in a pediatric population-based cohort","volume":"113","author":"Figueiredo","year":"2019","journal-title":"Trans. R Soc. Trop. Med. Hyg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e123","DOI":"10.1038\/emi.2016.124","article-title":"Consecutive large dengue outbreaks in Taiwan in 2014\u20132015","volume":"5","author":"Wang","year":"2016","journal-title":"Emerg. Microbes. Infect."}],"container-title":["Tropical Medicine and Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2414-6366\/8\/4\/188\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:03:01Z","timestamp":1760122981000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2414-6366\/8\/4\/188"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,25]]},"references-count":34,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["tropicalmed8040188"],"URL":"https:\/\/doi.org\/10.3390\/tropicalmed8040188","relation":{},"ISSN":["2414-6366"],"issn-type":[{"value":"2414-6366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,25]]}}}