Altmetric

Cardio-haemodynamic assessment and venous lactate in severe dengue: Relationship with recurrent shock and respiratory distress

File Description SizeFormat 
journal.pntd.0005740.pdfPublished version1.37 MBAdobe PDFView/Open
Title: Cardio-haemodynamic assessment and venous lactate in severe dengue: Relationship with recurrent shock and respiratory distress
Authors: Yacoub, S
Trieu, HT
Phung, KL
Vuong, HNT
Duong, HTH
Tu, QP
Oanh, PKN
Nguyen, THQ
Simmons, CP
Broyd, C
Screaton, GR
Wills, B
Item Type: Journal Article
Abstract: Background Dengue can cause plasma leakage that may lead to dengue shock syndrome (DSS). In approximately 30% of DSS cases, recurrent episodes of shock occur. These patients have a higher risk of fluid overload, respiratory distress and poor outcomes. We investigated the association of echocardiographically-derived cardiac function and intravascular volume parameters plus lactate levels, with the outcomes of recurrent shock and respiratory distress in severe dengue. Methods/Principle findings We performed a prospective observational study in Paediatric and adult ICU, at the Hospital for Tropical Diseases (HTD), Ho Chi Minh City, Vietnam. Patients with dengue were enrolled within 12 hours of admission to paediatric or adult ICU. A haemodynamic assessment and portable echocardiograms were carried out daily for 5 days from enrolment and all interventions recorded. 102 patients were enrolled; 22 patients did not develop DSS, 48 had a single episode of shock and 32 had recurrent shock. Patients with recurrent shock had a higher enrolment pulse than those with 1 episode or no shock (median: 114 vs. 100 vs. 100 b/min, P = 0.002), significantly lower Stroke Volume Index (SVI), (median: 21.6 vs. 22.8 vs. 26.8mls/m2, P<0.001) and higher lactate levels (4.2 vs. 2.9 vs. 2.2 mmol/l, P = 0.001). Higher SVI and worse left ventricular function (higher Left Myocardial Performance Index) on study days 3–5 was associated with the secondary endpoint of respiratory distress. There was an association between the total IV fluid administered during the ICU admission and respiratory distress (OR: 1.03, 95% CI 1.01–1.06, P = 0.001). Admission lactate levels predicted patients who subsequently developed recurrent shock (P = 0.004), and correlated positively with the total IV fluid volume received (rho: 0.323, P = 0.001) and also with admission ALT (rho: 0.764, P<0.001) and AST (rho: 0.773, P<0.001). Conclusions/Significance Echo-derived intravascular volume assessment and venous lactate levels can help identify dengue patients at high risk of recurrent shock and respiratory distress in ICU. These findings may serve to, not only assist in the management of DSS patients, but also these haemodynamic endpoints could be used in future dengue fluid intervention trials.
Issue Date: 10-Jul-2017
Date of Acceptance: 23-Jun-2017
URI: http://hdl.handle.net/10044/1/58713
DOI: https://dx.doi.org/10.1371/journal.pntd.0005740
ISSN: 1935-2735
Publisher: PUBLIC LIBRARY OF SCIENCE
Journal / Book Title: PLOS NEGLECTED TROPICAL DISEASES
Volume: 11
Issue: 7
Copyright Statement: © 2017 Yacoub et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Sponsor/Funder: Medical Research Council (MRC)
Medical Research Council (MRC)
Funder's Grant Number: G0600000
G0801508
Keywords: Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
Parasitology
Tropical Medicine
FLUID RESPONSIVENESS
SERUM LACTATE
INFECTION
MORTALITY
SEPSIS
Adolescent
Child
Echocardiography
Female
Heart
Hemodynamics
Humans
Intensive Care Units
Lactic Acid
Linear Models
Male
Prospective Studies
Severe Dengue
Shock
Vietnam
Young Adult
06 Biological Sciences
11 Medical And Health Sciences
Publication Status: Published
Article Number: ARTN e0005740
Appears in Collections:Department of Medicine
Faculty of Medicine



Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Creative Commons