Clinical, Laboratory and Plasma Leakage Profile of Dengue Fever in Children: Determinants of Disease Severity in a Tertiary Care Centre

Background: Early risk stratification is critical to successfully manage severe dengue disease and prevent clinical deterioration. This study aims to evaluate the clinical profile of paediatric dengue and assess the diagnostic utility of the novel Dengue Severity Prediction Index (DSPI) and Plasma Leakage Status (PLS). Material and Methods: A retrospective cross-sectional study was conducted on 85 children (aged 1–12 years) with laboratory-confirmed dengue at a tertiary care teaching hospital. The DSPI (scored from 0 to 6) was developed by assigning one point each for the presence of thrombocytopenia (<100,000/mm³), leukopenia (<4000/mm³), clinical shock, and ultrasonographic evidence of ascites, pleural effusion, and gallbladder wall edema. The study analysed associations between the DSPI, overall PLS, and World Health Organization (WHO) 2009 severity classifications. Results: The paediatric cohort had a mean age of 6.88 years with a male predominance (64.7%). According to WHO 2009 criteria, 51.8% of patients presented with warning signs and 21.2% had severe dengue. The DSPI demonstrated a highly significant correlation with the patients' plasma leakage burden (p < 0.001). Children with low DSPI scores (0–1) had no evidence of plasma leakage, whereas those with high scores (≥4) predominantly exhibited moderate-to-severe plasma leakage. Receiver operating characteristic (ROC) analysis revealed excellent discriminatory power for identifying severe dengue, yielding an area under the curve (AUC) of 0.992. Using an optimal cut-off of DSPI provided 100% sensitivity and 97.0% specificity. Conclusion: The DSPI is a highly sensitive and specific prognostic tool that successfully integrates routine clinical, laboratory, and ultrasonographic markers. Even at a minimal threshold, it offers exceptional utility for the early detection of severe dengue, facilitating timely and life-saving interventions in vulnerable paediatric patients.

Keywords: Dengue fever, plasma leakage, Dengue Severity Prediction Index (DSPI), ultrasonography, risk stratification, prognostic markers, thrombocytopenia.