Implementation of Dengue Recurrent Shock Prediction Score in pediatric dengue shock syndrome

Abstract Background Global morbidities due to dengue viral infection increase yearly. The pediatric mortality rate from dengue shock syndrome (DSS) remains high. Early identification of the risk of recurrent shock may serve to increase awareness and reduce mortality. The Dengue Recurrent Shock Prediction Score (DRSPS) is a tool to predict recurrent shock in children with DSS, but the optimal cut-off point in our population is still unknown. Objective To assess the validity of the DRSPS by determining the optimal cut-off point that can be used in Indonesia Methods This cross-sectional prospective study was done at Sanglah Hospital, Denpasar, Bali. Risk of reccurent shock were classify based on DRSPS in all DSS patient, and they were observed whether they will experienced recurrent shock or not. Results Of 56 children with DSS, 27 subjects had recurrent shock and 29 subjects did not. The optimal DRSPS cut-off point was -189.9 for predicting recurrent shock, with 87.4% area under the curve (AUC), 81.5% sensitivity and 82.8% specificity. Conclusion The optimal cut-off point of DRSPS was -189.9 and it has good validity. The results of this study are expected not only to be used as the basis for further study, but to increase physician awareness in treating DSS patients. [Paediatr Indones. 2020;60:178-85 ; DOI: 10.14238/pi60.4.2020.178-85]. Keywords: dengue shock syndrome; recurrent shock; DRSPS The national mortality rate of dengue hemorrhagic fever (DHF) declined from 41.4% in 1968, to 4% in 1980, to 1.4% in 2000, and to only 0.88% in 2012. However, the number of deaths due to dengue shock syndrome (DSS) remain high. Data from six teaching hospitals in Indonesia in 2008-2013 revealed that the mortality rate due to DSS was about 7.81%, reaching 10-20% if proper initial treatment is lacking.1 Hence, we need to better identify the risk factors of shock in children with dengue infection, with the aim of increasing physician awareness for stricter supervision of patients.1,2 Deaths from dengue infections were reported to be fifty times higher in patients with shock than those without shock. About 30% of shock patients experience recurrent shock, affecting subsequent treatment and outcomes. In 2016, there were 245 pediatric DSS cases in RSUP Sanglah, Bali, of whom 119 cases (48.5%) had recurrent shock.2 Recurrent shock generally occurs during the critical phase of