Obesity as a risk factor for dengue shock syndrome in children

Background Dengue hemorrhagic fever (DHF) leads to high morbidity and mortality if not be treated properly and promptly. Obesity may play a role in the progression ofDHF to dengue shock syndrome (DSS) and could be a prognostic factor. Objective To evaluate childhood obesity as a prognostic factor for DSS. Methods We reviewed medical records of patients with DHF and DSS admitted to Department of Child Health, Dr. Sardjito Hospital, Yogyakarta between June 2008 and February 2011. Subjects were aged less than 18 years and fulfilled WHO criteria (1997) for DHF or DSS. The exclusion criteria were the dengue fever, a milder form of disease, or other viral infections. Risk factors for DSS were analyzed by logistic regression analysis. Results Of342 patients who met the inclusion criteria, there were 116 DSS patients (33 .9%) as the case group and 226 DHF patients (66.1%) as the control group. Univariate analysis revealed that risk factors for DSS were obesity (OR= 1.88; 95%CI 1.01 to3.5 l) , secondary infection type (OR=0.82; 95%CI 0.41 to 1.63), plasma leakage with hematocrit increase> 25% (OR=3.42; 95%CI 2.06 to 5.65), platelet count < 20,000/μL (OR= l.95; 95%CI 1.20 to 3 .16), and inadequate fluid management from prior hospitalization (OR=9.ll; 95% CI 1.13 to 73.66). By multivariate analysis, plasma leakage with hematocrit increase > 25% was associated with DSS (OR=2.5 l; 95%CI 1.12 to 5.59), while obesity was not associated with DSS (OR= l.03; 95%CI 0.32 to3.3 1). Conclusion Obesity is not a risk factor for DSS, while plasma leakage with hematocrit increase > 25% is associated with DSS