Table 2.
Results of meta-analysis for the clinical characteristics between severe dengue and dengue fever with or without warning signs.
| Clinical characteristics | Number of studies | Total events | Odds ratio | Z | Test for OR | Test of heterogeneity | Model | |
|---|---|---|---|---|---|---|---|---|
| SD/DF | (95% CI) | P-value | I2 (%) | P-value | ||||
| Demographic characteristics | ||||||||
| Gender (Male) | 22 | 584/2483 | 0.95 (0.77–1.16) | 0.53 | 0.60 | 33 | 0.04 | Random |
| Gender (Female) | 17 | 485/1199 | 1.30 (0.95–1.77) | 1.66 | 0.10 | 62 | <0.001 | Random |
| Comorbidity | 8 | 100/545 | 2.03 (1.09–3.78) | 2.24 | 0.03 | 70 | <0.001 | Random |
| Probable dengue | ||||||||
| Fever | 14 | 951/3076 | 0.74 (0.34–1.60) | 0.77 | 0.44 | 52 | 0.01 | Random |
| Nausea | 8 | 140/461 | 0.92 (0.66–1.27) | 0.53 | 0.60 | 13 | 0.32 | Fixed |
| Vomiting | 19 | 849/2275 | 2.18 (1.50–3.16) | 4.12 | <0.001 | 77 | <0.001 | Random |
| Rash | 22 | 395/1569 | 1.07 (0.84–1.37) | 0.55 | 0.58 | 41 | 0.01 | Random |
| Headache | 18 | 505/2388 | 0.84 (0.70–1.00) | 2.00 | 0.05 | 28 | 0.11 | Fixed |
| Retro-orbital pain | 13 | 172/726 | 0.99 (0.75–1.30) | 0.10 | 0.92 | 0 | 0.73 | Fixed |
| Arthralgia | 16 | 281/1566 | 1.10 (0.89–1.36) | 0.86 | 0.39 | 0 | 0.55 | Fixed |
| Myalgia | 17 | 451/2498 | 1.01 (0.83–1.24) | 0.11 | 0.92 | 0 | 0.53 | Fixed |
| Tourniquet test (+) | 7 | 108/349 | 0.52 (0.19–1.44) | 1.27 | 0.21 | 68 | <0.01 | Random |
| Leucopenia | 14 | 275/1578 | 0.82 (0.59–1.15) | 1.15 | 0.25 | 35 | 0.06 | Random |
| Warning signs | ||||||||
| Abdominal pain or tenderness | 33 | 1338/2554 | 2.00 (1.49–2.68) | 4.62 | <0.001 | 75 | <0.001 | Random |
| Persistent vomiting | 12 | 296/465 | 2.57 (1.40–4.73) | 3.04 | 0.002 | 80 | <0.001 | Random |
| Clinical fluid accumulation | ||||||||
| Pleural effusion | 14 | 397/264 | 6.20 (3.66–10.51) | 6.77 | <0.001 | 65 | <0.001 | Random |
| Ascites | 15 | 420/266 | 5.20 (3.27–8.29) | 6.94 | <0.001 | 54 | 0.002 | Random |
| Gall bladder wall thickening | 4 | 141/80 | 5.61 (2.73–11.53) | 4.69 | <0.001 | 31 | 0.19 | Fixed |
| Mucosal bleeding | ||||||||
| Epistaxis | 9 | 73/110 | 2.23 (1.04–4.77) | 2.07 | 0.04 | 65 | 0.001 | Random |
| Gum bleeding | 10 | 48/208 | 3.34 (1.60–6.98) | 3.21 | <0.01 | 49 | 0.02 | Random |
| GI bleeding (hematemesis and/or melena) | 10 | 104/89 | 14.56 (5.38–39.39) | 5.27 | <0.001 | 74 | <0.001 | Random |
| Hematuria | 4 | 4/22 | 2.48 (0.75–8.25) | 1.48 | 0.14 | 0 | 0.53 | Fixed |
| Vaginal bleeding | 4 | 20/21 | 6.62 (0.38–114.64) | 1.30 | 0.19 | 75 | <0.01 | Random |
| Skin bleeding (petechiae, purpura, ecchymosis) | 19 | 386/723 | 2.12 (1.53–3.19) | 4.22 | <0.001 | 62 | <0.001 | Random |
| Lethargy or restlessness | 13 | 464/755 | 4.32 (1.86–10.04) | 3.40 | <0.001 | 89 | <0.001 | Random |
| Hepatomegaly > 2 cm | 25 | 796/730 | 3.34 (2.38–4.68) | 7.00 | <0.001 | 66 | <0.001 | Random |
| Increased HCT with decreased platelets | 7 | 170/224 | 3.19 (1.36–7.46) | 2.68 | 0.007 | 59 | 0.02 | Random |
| Severe dengue | ||||||||
| Severe plasma leakage | ||||||||
| Shock | 6 | 235/3 | 47.51 (14.80 -152.50) | 8.85 | <0.001 | 35 | 0.15 | Fixed |
| Dyspnea | 6 | 99/44 | 11.19 (6.91–18.11) | 9.82 | <0.001 | 0 | 0.56 | Fixed |
| Severe organ involvement | ||||||||
| Elevated ALT (>40 u/L) | 7 | 290/582 | 3.24 (1.87–5.61) | 4.19 | <0.001 | 51 | 0.04 | Random |
| Elevated AST (>40 u/L) | 8 | 338/790 | 3.75 (2.11–6.68) | 4.49 | <0.001 | 51 | 0.03 | Random |
| Impaired consciousness | 5 | 37/30 | 29.81 (4.08–217.94) | 3.34 | <0.001 | 74 | 0.002 | Random |
| Splenomegaly | 6 | 34/75 | 1.33 (0.81–2.18) | 1.14 | 0.25 | 0 | 0.76 | Fixed |
| Others | ||||||||
| Cough | 6 | 36/398 | 1.08 (0.73–1.59) | 0.39 | 0.70 | 0 | 0.60 | Fixed |
| Diarrhea | 12 | 71/704 | 1.02 (0.76–1.36) | 0.13 | 0.89 | 0 | 0.99 | Fixed |
| Thrombocytopenia (platelets <150*109/L) | 18 | 893/3282 | 2.70 (1.60–4.55) | 3.73 | <0.001 | 68 | <0.001 | Random |
| Hypoalbuminemia | 7 | 152/776 | 2.25 (0.85–5.92) | 1.64 | 0.10 | 78 | <0.001 | Random |
| Primary infection | 4 | 11/83 | 0.43 (0.09–2.04) | 1.07 | 0.29 | 64 | 0.03 | Random |
| Secondary infection | 5 | 96/310 | 1.93 (1.25–2.97) | 2.96 | 0.003 | 0 | 0.50 | Random |
Notes: SD = Severe dengue; DF = Dengue fever; HCT = Hematocrit; ALT = Alanine transaminase; AST = Aspartate transaminase.