Dynamic Measurement of Hemodynamic Parameters and Cardiac Preload in Adults with Dengue: A Prospective Observational Study.

Few previous studies have monitored hemodynamic parameters to determine the physiological process of dengue or examined inferior vena cava (IVC) parameters to assess cardiac preload during the clinical phase of dengue. From January 2013 to July 2015, we prospectively studied 162 hospitalized adults with confirmed dengue viral infection using non-invasive cardiac output monitoring and bedside ultrasonography to determine changes in hemodynamic and IVC parameters and identify the types of circulatory shock that occur in patients with dengue. Of 162 patients with dengue, 17 (10.5%) experienced dengue shock and 145 (89.5%) did not. In patients with shock, the mean arterial pressure was significantly lower on day 6 after fever onset (P = 0.045) and the pulse pressure was significantly lower between days 4 and 7 (P<0.05). The stroke volume index and cardiac index were significantly decreased between days 4 and 15 and between days 5 and 8 after fever onset (P<0.05), respectively. A significant proportion of patients with dengue shock had an IVC diameter <1.5 cm and IVC collapsibility index >50% between days 4 and 5 (P<0.05). Hypovolemic shock was observed in 9 (52.9%) patients and cardiogenic shock in 8 (47.1%), with a median (interquartile range) time to shock onset of 6.0 (5.0-6.5) days after fever onset, which was the median day of defervescence. Intravascular hypovolemia occurred before defervescence, whereas myocardial dysfunction occurred on the day of defervescence until 2 weeks after fever onset. Hypovolemic shock and cardiogenic shock each occurred in approximately half of the patients with dengue shock. Therefore, dynamic measures to estimate changes in hemodynamic parameters and preload should be monitored to ensure adequate fluid therapy among patients with dengue, particularly patients with dengue shock

Change in hematocrit (Hct) from baseline (%) by day after fever onset among patients with and without dengue shock.

<p>Change in hematocrit (Hct) from baseline (%) by day after fever onset among patients with and without dengue shock.</p

Daily cumulative fluid balance (mL) by day after fluid therapy among patients with and without dengue shock.

<p>Daily cumulative fluid balance (mL) by day after fluid therapy among patients with and without dengue shock.</p

Baseline characteristics, clinical parameters, laboratory parameters, and outcomes among 162 hospitalized adults with dengue, subdivided by patients with and without dengue shock.

<p>Baseline characteristics, clinical parameters, laboratory parameters, and outcomes among 162 hospitalized adults with dengue, subdivided by patients with and without dengue shock.</p

Inferior vena cava parameters by day after fever onset among patients with and without dengue shock.

<p>(A) A Bland-Altman plot of data from the intraobserver reliability study. The mean IVCdmax (cm) of each patient was plotted against the difference in IVCd (cm) between two measurements (811 measurements each) obtained by the same observer. (B) A Bland-Altman plot of data from the intraobserver reliability study. The mean IVCdmin (cm) of each patient was plotted against the difference in IVCd (cm) between two measurements (811 measurements each) obtained by the same observer. (C) IVCd (cm) after fever onset among patients with and without dengue shock (D) IVCc (%) after fever onset among patients with and without dengue shock. IVCc = Inferior vena cava collapsibility index; IVCd = inferior vena cava diameter; IVCdmax = maximum inferior vena cava diameter; IVCdmin = minimum inferior vena cava diameter; LLA = lower limit of agreement; NA = not applicable; ULA = upper limit of agreement.</p

Hemodynamic parameters by day after fever onset among patients with and without dengue shock.

<p>(A) MAP (mmHg) after fever onset among patients with and without dengue shock. (B) PP (mmHg) after fever onset among patients with and without dengue shock. (C) HR (beats/min) after fever onset among patients with and without dengue shock. (D) CI (L/min/m²) after fever onset among patients with and without dengue shock. (E) TPRI (dynes∙sec/cm⁵/m²) after fever onset among patients with and without dengue shock. (F) SVI (mL/m²/beat) after fever onset among patients with and without dengue shock. CI = cardiac index; HR = heart rate; MAP = mean arterial pressure; NA = not applicable; PP = pulse pressure; SVI = stroke volume index; TPRI = total peripheral resistance index.</p