Early Differentiation Between Dengue and Septic Shock by Comparison of Admission Hemodynamic, Clinical, and Laboratory Variables: A Pilot Study

Objective: To compare the clinical, hemodynamic, and laboratory variables, treatment, and outcome in dengue shock syndrome (DSS) and septic shock (SS), with an aim to permit early differentiation at presentation to the emergency department.

Design: Retrospective chart review.

Setting: A tertiary care pediatric emergency and critical care unit.

Patients: Thirty-two patients (16 DSS and 16 SS) between June 2004 and December 2005 who were treated in the emergency department and intensive care using protocols.

Interventions: None.

Results: There were no differences between groups in terms of age, number with decompensated shock, and Pediatric Risk of Mortality III scores. Differences between DSS and SS were found in heart rate, 120 ± 39 beats per minute versus 158 ± 35 beats per minute (P< 0.01); pulse pressures, 25 ± 8 mm Hg versus 43 ± 8 mm Hg (P< 0.01); presence of systemic inflammatory response syndrome, 9/16 versus 15/16 (P < 0.05); Glasgow Coma Score, 13 ± 3 versus 10 ± 4 (P < 0.05); hematocrit, 42 ± 6 versus 29 ± 7 (P < 0.01); and median platelet count, 29,000/mm³ (interquartile range, 20,500-57,500/mm³) versus 115,500/mm³ (interquartile range, 91,750-182,250/mm³ in SS) (P < 0.01).

Patients with SS were more likely to require greater than 40 mL/kg of fluid for initial resuscitation, ventilation, and vasoactive support for shock compared with those with dengue. In the fluid and catecholamine refractory patients, 6 of 16 SS versus 0 of 16 DSS patients were treated with steroids (P < 0.05). The outcome was similar in both groups, with 2 of 16 deaths among children with SS and 1 of 16 in those with DSS.

Conclusions: Dengue shock syndrome is likely a distinct entity from SS with some overlapping features. The DSS patients are significantly less likely to have systemic inflammatory response syndrome, be tachycardic, and have a narrower pulse pressure at admission when compared with SS patients. Mental status is better preserved, and spontaneous clinical bleeding is more common in children with DSS compared with those in SS. These likely results from the predominantly vasodilatory state in SS versus vasoconstrictory state that is the initial response in DSS.