Paediatrica Indonesiana

VOLUME 52 July ‡ NUMBER 4

Original Article

The relationship between pleural effusion index and

mortality in children with dengue shock syndrome
Novrianti Hawarini1, Muhammad Sholeh Kosim1, M Supriatna1, Yusrina Istanti1, Eddy Sudijanto2

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Abstract engue hemorrhagic fever is an important
Background 'HQJXHVKRFNV\QGURPH'66PRUWDOLW\UDWHLVVWLOO cause of morbidity in Asian children,
KLJK7KHH[WHQWRISODVPDHIIXVLRQLQGHQJXHVKRFNV\QGURPH DQG GHQJXH VKRFN V\QGURPH FDXVHV D
can be identified in the right lateral decubitus position on chest
significant number of childhood deaths.
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thought that 3(,YDOXHFDQEHXVHGWRSUHGLFW'66PRUWDOLW\LQ '66 LV FKDUDFWHUL]HG E\ D PDVVLYH LQFUHDVH LQ
FKLOGUHQ3OHXUDOHIIXVLRQLQ'66SDWLHQWVFDQFDXVHUHVSLUDWRU\ V\VWHPLF FDSLOODU\ SHUPHDELOLW\ ZLWK FRQVHTXHQW
failure and death. hypovolemia.
Objective 7R GHWHUPLQH WKH UHODWLRQVKLS EHWZHHQ 3(, DQG  :+2 GHILQHV '66 DV '+) SOXV VLJQV RI
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Methods This cross-sectional, retrospective study was held in the
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'U.DULDGL+RVSLWDO6HPDUDQJ,QGRQHVLD'DWDZDVWDNHQIURP QDUURZSXOVHSUHVVXUH”PP+JRUK\SRWHQVLRQ
PHGLFDOUHFRUGVRISHGLDWULFLQWHQVLYHFDUHXQLW3,&8SDWLHQWV for age, prolonged capillary refill, cold and clammy
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occurs at the time of defervescence, usually after
diagnosis was established by the presence of fluid in the pleural
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logistic regression tests were used to analyze the data. DVZHOODVUDSLGDQGIHHEOHSXOVH3OHXUDOHIIXVLRQDQG
Results There were VXEMHFWVZLWK'66FRQVLVWLQJRIPDOHV ascites measurements may be used to predict the
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survived and  GLHG2QHSDWLHQWKDG3(,
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Conclution 3(,!ZDVDULVNIDFWRUIRUPRUWDOLW\LQFKLOGUHQ 6FKRRO 'U .DULDGL +RVSLWDO 6HPDUDQJ ,QGRQHVLD. Department of
ZLWK'66[Paediatr Indones. 2012;52:239-42]. 5DGLRORJ\ )DFXOW\ RI 0HGLFLQH 'LSRQHJRUR 8QLYHUVLW\ 'U .DULDGL
+RVSLWDO6HPDUDQJ,QGRQHVLD2

Keywords: pleural effusion index, mortality in Reprint requests to: 1RYULDQWL+DZDULQL'HSDUWPHQWRI&KLOG+HDOWK

dengue shock syndrome 'LSRQHJRUR 8QLYHUVLW\ 0HGLFDO 6FKRRO 'U .DULDGL +RVSLWDO -O 'U
6RHWRPR QR  6HPDUDQJ ,QGRQHVLD  (PDLO novrianti_dr@
yahoo.com

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5DGLRORJ\&RQJUHVVLQ.XWD%DOL,QGRQHVLD1RYHPEHU

Paediatr Indones, Vol. 52, No. 4, July 2012 ‡239

 Novrianti Hawarini et al:3OHXUDOHIIXVLRQLQGH[DQGPRUWDOLW\LQGHQJXHVKRFNV\QGURPH

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reduced functional residual capacity. Furthermore,
pleural effusion causes hypoxemia and increased Discussion
breathing effort. Clinical manifestations caused by
pleural effusion depend upon the volume of pleural This study was conducted to determine the relationship
fluid, in addition to lung parenchymal pathology, such RI SODVPD OHDNDJH VHYHULW\ DV PHDVXUHG E\ 3(, WR
as acute respiratory distress syndrome. PRUWDOLW\LQ'66SDWLHQWV
Right lateral decubitus position on chest x-ray 6XEMHFWV·JHQGHUVLQRXUVWXG\ZHUHPDOH
is used to evaluate pleural effusion. The degree of DQG  IHPDOH $  6LQJDSRUHDQ VWXG\
SODVPD OHDNDJH PD\ EH TXDQWLILHG E\ WKH 3(, 3(, reported a higher number of cases of men than
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of the right pleural effusion, divided by the maximal VWXG\UHSRUWHGJLUOVWREHWZRWLPHVPRUHIUHTXHQWO\
width of the right hemithorax. hospitalized due to dengue.,QD,QGRQHVLDQ
The objective of this study was to evaluate VWXG\ FLWHG IURP 6XSULDWQD 06 WKHUH ZDV QR
WKHXVHRI3(,YDOXHVWRSUHGLFWPRUWDOLW\LQ'66LQ significant difference between males and females in
children. WKHQXPEHURI'+)FDVHVDQGVKRFNHYHQWV
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Methods ZDVUHSRUWHGWREHORZLQDQGUHPDLQVWR
be below 3%.,Q6HPDUDQJLQWKHUHZHUH
The retrospective, cross-sectional study was held in GHQJXHFDVHVZLWKDQLQFLGHQFHUDWHRISHU
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who fulfilled the inclusion criteria. Eligible subjects
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diagnosis was confirmed by clinical and radiological
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position on chest x-rays and calculated by the formula
$%[(Figure 1).8
Radiological examination results were reviewed
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Results
Table 1%JCTCEVGTKUVKEUQHUWDLGEVU
7KHUHZHUH3,&8FDVHVRI'66IURP-DQXDU\ Characteristics n = 48 %
WR-DQXDULFRQVLVWLQJRIPDOHVDQG
IHPDOHV7ZHQW\QLQHVXEMHFWVVXUYLYHG 5GZ
Male 18 37.5
DQGGLHGDVVKRZQLQTable 1. Table 2 shows Female 30 62.5
WKH3(,JURXSLQJVEDVHGRQ[UD\ILQGLQJV Mortality status
7KHUHODWLRQVKLSRI3(,WRGHDWKZDVREVHUYHG Survived 29 60.4
LQ3(,YDOXHVRIJUHDWHUWKDQZLWKDVWDWLVWLFDOO\ Died 19 39.6

240‡Paediatr Indones, Vol. 52, No. 4, July 2012

 Novrianti Hawarini et al:3OHXUDOHIIXVLRQLQGH[DQGPRUWDOLW\LQGHQJXHVKRFNV\QGURPH

'66LVGHILQHGDV'+)ZLWKVLJQVRIFLUFXODWRU\ randomized double-blind comparison of 4 intravenous fluid

IDLOXUHLQFOXGLQJQDUURZSXOVHSUHVVXUHPP+J regimens in the first hour. Clin Infect Dis.
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'66GHSHQGVRQSUHYHQWLRQRUHDUO\UHFRJQLWLRQDQG management of dengue complication in pediatric. Indonesian
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Table 22'+ITQWRKPIUDCUGFQPEJGUVZTC[ſPFKPIU IDFWRUVIRUPRUWDOLW\LQGHQJXHVKRFNV\QGURPH'660HGLD
PEI n = 48 % 0HGLND,QGRQHVLDQD
< 6% 1 2.1  $JDUDO5.DSRRU61DJDU50LVUD$7DQGRQ50DWKXU$
6-15% 4 8.3 et al. A clinical study ofthe patients with dengue hemorrhagic
15-30% 17 35.4
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>30% 26 54.2
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Table 3. 4GNCVKQPUJKRQHOQTVCNKV[TCVGUVQ2'+
PEI Death OR 95% CI P
n (%)
15-30% 2 (11.8) 0.110 0.021 to 0.564 <0.005

>30% 17 (65.4) 18,889 3,581 to 99,642 <0.005

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A limitation of our study was that we could not 
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findings, since this was a retrospective study. IHYHUGHQJXHKHPRUUKDJLFIHYHULQ6LQJDSRUH(SLGHPLRORJLFDO
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Paediatr Indones, Vol. 52, No. 4, July 2012 ‡241

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EJ, Vorndam AV. Dengue and dengue haemorrhagic fever. GHQJXH,Q+DUXQ656DWDUL+,HGLWRUV1DVNDKOHQJNDS
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242‡Paediatr Indones, Vol. 52, No. 4, July 2012