ĐẶC ĐIỂM DỊCH TỄ, LÂM SÀNG VÀ CẬN LÂM SÀNG Ở TRẺ SỐC SỐT XUẤT HUYẾT DENGUE TẠI THỜI ĐIỂM VÀO SỐC: MỘT NGHIÊN CỨU MÔ TẢ CẮT NGANG

Abstract

Background: Dengue shock syndrome (DSS) represents the most severe manifestation of dengue infection, characterized by acute plasma leakage and hemodynamic instability. Early recognition of epidemiological and laboratory features at shock onset is crucial for severity assessment and clinical management. Objective: To describe the epidemiological, clinical, and laboratory characteristics of pediatric patients with dengue shock at the time of shock onset. Methods: This cross-sectional study, combining retrospective and prospective data, included 96 children younger than 16 years diagnosed with dengue shock at Tien Giang General Hospital between July 2023 and July 2025. Demographic, anthropometric, clinical, and laboratory variables were collected at shock onset, including hematological indices, serum lactate, arterial blood gas analysis, liver enzymes, and ultrasonographic evidence of plasma leakage. Results: The mean age was 11.2±2.7 years, with 59.4% aged 6–12 years; 57.3% were male, and 49.0% were overweight or obese. Shock occurred predominantly on illness days 4–5 (84.4%), with 76.0% classified as dengue shock syndrome and 24.0% as severe dengue shock. At shock onset, patients demonstrated marked hemoconcentration (hematocrit 49.1±4.0%), leukopenia (4,270±2,063/mm³), and severe thrombocytopenia (35,960±17,451/mm³). Serum lactate was elevated (2.7±1.4 mmol/L). Arterial blood gas analysis revealed mild mixed acid–base disturbances (PaCO₂ 29.9±5.2 mmHg; HCO₃⁻ 19.3±3.1 mmol/L; base excess −5.2±3.4 mmol/L). Liver enzymes were increased, with AST predominating over ALT (192.5±281.8 U/L vs. 90.9±135.4 U/L). Ultrasonography showed predominantly mild to moderate ascites (92.7%). Conclusions: At shock onset, pediatric dengue shock is most observed in school-aged children, with a high prevalence of overweight and obesity and characteristic laboratory abnormalities reflecting plasma leakage, impaired tissue perfusion, and metabolic disturbances. These findings underscore the importance of comprehensive early assessment at shock onset to guide monitoring and optimizing management strategies