PICO

Population Individuals with severe dengue virus infection

Intervention
Identify risk factors and predictors of severe dengue, like
Characteristics, co-morbidities, and warning signs using an
inverse variance heterogeneity model.
Comparison
Female, being a child, secondary infection, patient with
diabetes and renal disease is more risk to had a warning sign
of dengue.
Outcomes The patient with risk factor and warning sign is more risk to
be severe dengue

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 CRITICAL APPRAISAL

A. Are the results of the review valid?

Yes Can’t tell No
1.Did the review
address a clearly focused
question?
2.Did the authors
look for the right type of
papers?
3.Do you think all the
important, relevant studies
were included?
4.Did the review’s authors do
enough to assess quality of the
included
studies?
5.If the results of the review
have been combined, was it
reasonable
to do so?

B. What are the results?

6. What are the overall results of
the review?
There were 143 records that included in
systematic review and meta-analysis.
Children were positively associated with
the development of severe disease as
compared to adults (OR=1.96, 95% CI:
1.22–3.13). Progression to severe dengue
did not show a significant difference by
sex (OR=1.20, 95% CI: 0.79–1.82).
Secondary dengue infection was found to
be significantly associated with the
development of severe disease (OR=3.23,
95% CI: 2.28–4.57).
Diabetes (OR=2.88 95% CI: 1.72–4.81)
and renal disease(s) (OR=4.85, 95% CI:
1.08–21.66) were associated with severe

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dengue.
However, other co-morbidities including
hypertension (OR=1.82, 95% CI: 0.98–
3.37), CVD (OR=2.27, 95% CI: 0.38–
13.71), and obesity (OR=0.76, 95% CI:
0.41–1.40) were not significantly
associated with the severe disease.
Progression to severe dengue was
associated with a concurrent increase in
haematocrit and decrease in platelet count
compared to normal values (OR = 5.13,
95% CI: 1.61–16.34), abdominal pain (OR
= 2.00, 95% CI: 1.49–2.68), lethargy (OR
= 2.73, 95% CI: 1.05–7.09), vomiting (OR
= 1.80, 95% CI: 1.43–2.26) and enlarged
liver (OR = 5.92, 95% CI: 3.29–10.65) In
terms of clinical fluid accumulation, both
ascites (OR = 6.94, 95% CI: 3.75–10.60)
and pleural effusion (OR = 5.72, 95% CI:
3.24–10.10) were significantly associated
with severe dengue. In terms of mucosal
bleeding, haematemesis (OR = 12.35, 95%
CI: 4.97–30.72) was significantly
associated, while gum bleeding (OR =
2.00, 95% CI: 0.86–4.66) and epistaxis
(OR = 1.85, 95% CI: 0.72–4.70) were not
significantly associated with severe
dengue. In addition, GI bleeding (OR =
9.49, 95% CI: 2.75–32.70) and melena
(OR = 4.05, 95% CI: 1.69–10.00) were
also found to be positively associated with

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7. How precise are the results?
severe disease.
All predictors that were significantly
associated in the main analysis also
showed similar results in the stratified
analysis using the WHO 1997 and 2009
dengue case classifications. Using the
quality effects model, all pooled
estimates were found to be consistent
with the main analysis.

C. Will the results help locally?

Yes Can’t Tell No
8. Can the results be
applied to the local population?

9. Were all
important outcomes considered?

10. Are the benefits

worth the harms and cost?

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