To identify the role of haemoglobin (Hb), pack cell volume (PCV) and pulse pressure (PP) in predicting fluid leakage in patients with dengue who consume adequate amounts of fluids

Abstract

BACKGROUND: Early detection of fluid leakage is important in identifying patients who are likely to develop shock syndrome in dengue. As patients with dengue are advised to consume adequate amounts of fluids such behaviours may alter the clinical and haematological parameters predicting fluid leakage. METHODS: In 102 confirmed dengue patients admitted to Professorial Medical Unit, Colombo North Teaching Hospital Ragama from September 2011,quantity and quality of fluids consumed, Hb, PCV, PP and their percentage rise or decline were documented and compared between those who developed and did not develop moderate third space fluid accumulation (3rdSFA) [either pleural effusions, ascites or both detected by ultrasonography. RESULTS: In 102 patients (52 males) with mean (SD) age 28.3 (11.8) years, 3rd SFA was detected in 7/102 (6.8%) on admission and 34/95 (37%) after admission. Compared with those who had 3rdSFA and did not have 3rdSFA at admission; average consumption of water 1044cc/day vs 1091cc/day (p=0.8) and solutes 1050cc/day vs 805cc/day (P=0.26); the mean(SD) Hb 14.7 (2.0) g/dl vs 13.6 (1.8) g/dl (p=0.1); PCV 43.8 (6.5) vs 41.2 (5) (p=0.19); mean pulse pressure 32.8mmHg vs 33.8 (p=0.76). In those who developed 3rdSFA and did not develop 3rdSFA after admission, average consumption of water 620cc/day vs 491cc/day (p=0.14); solutes 1461cc/day vs 1481cc/day (p=0.83); the highest mean (SD) Hb 14.66g/dl (1.82)g/dl vs 14.28 (1.6)g/dl (p=0.3) and highest mean(SD) PCV 44.16 (5.19) vs 43.4 (4.5) (p=0.46); the mean (SD) pulse pressure 29.9mmHg vs 28.4 (p=0.29); The maximum percentage rise in Hb 8% vs 4.6% (p=0.02); PCV 8.6% vs 4.5% (p=0.006); mean pulse pressure drop 6.9% vs 5.9% (p=0.84). CONCLUSION: In the presence of fluid consumption the quality or quantity of fluids consumed did not seems to have played a role in 3rdSFA. A single value of Hb, PCV or pulse pressure was not helpful in predicting early fluid leakage. While percentage reduction in pulse pressure was not helpful, percentage rise in Hb and PCV remained predictive of early fluid leakage in dengue. © 2012 Elsevier Inc.