Browsing by Author "Ragupathy, A."

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Predictors of duration and degree of third space fluid accumulation in adult patients with dengue
(Sri Lanka Medical Association, 2012) Premaratna, R.; Ragupathy, A.; Miththinda, J.K.N.D.; de Silva, H.J.
INTRODUCTION: Fluid leakage is the hallmark of dengue shock syndrome. It is important to identify clinical and biochemical parameters which predict duration and degree of fluid leakage in dengue. METHODS: 102 patients with confirmed dengue were prospectively followed up for clinical, haematological and biochemical parameters, and they were correlated with ultrasonographic evidence of third space fluid accumulation (TSFA). RESULTS: Of the 102 patients (52 males; mean age 28.3 years(SD=11.8), TSFA was detected in 34/95(36%) after hospital admission; 33/95 had pleural effusions which included all except one of 21/95 who had ascites. 72.7% pleural effusions lasted 3 or more days and 52.4% ascites lasted less than 3 days. Duration of pleural effusion showed a significant positive correlation with maximum percentage rises of PCV (r=0.526,p=0.001) and Hb(r=0.525, p=0.001) and negatively correlated with WBC count (r=-0.361, p=0.020) and platelet count (r=-0.585, p=0.000). There was no correlation with any of the other parameters. The mean lowest WBC count of 3005/mm3that was recorded for patients who developed bilateral pleural effusions (n=21) was significantly less (p=0.042) than the mean lowest WBC count of 4091/mm3 that was detected for unilateral effusions(n=12). Duration of ascites was significantly positively correlated with highest AST(r=0.598, p=0.002) and highest ALT(n=0.721, p=.001. CONCLUSIONS: Maximum percentage rise of Hb and PCV, lower WBC and platelet counts seem to be associated TSFA. Among these, lower WBC counts appear to be more predictive of the degree of fluid leakage. Higher ALT and AST levels seem to be useful in predicting the duration of ascites.
Predictors of duration and degree of third space fluid accumulation in adult patients with dengue
(Elsevier, 2012) Premaratna, R.; Ragupathy, A.; Miththinda, N.; de Silva, H.J.
BACKGROUND: Fluid leakage is the hallmark of dengue shock syndrome. It is important to identify clinical and biochemical parameters which predict duration and degree of fluid leakage in dengue. METHODS: 102 patients with confirmed dengue were prospectively followed up for clinical, haematological and biochemical parameters parameters, and those were correlated with ultrasonographic evidence of third space fluid accumulation (TSFA). RESULTS: Of the 102 patients (52 males; mean age 28.3 years (SD 11.8), TSFA was detected in 34/95(36%) after hospital admission; 33/95 had pleural effusions which included all except one of 21/95 who had ascites. The majority of pleural effusions (72.7%) lasted 3 or more days and in most cases (52.4%) ascites lasted less than 3 days. Duration of pleural effusion showed a significant positive correlation with severity of body aches (assessed on a visual analogue scale) (r=0.523, p=0.001), maximum percentage rise of PCV (r=0.526, p=0.001) and maximum percentage rise of Hb (r=0.525, p=0.001). It was negatively correlated with WBC count (r= -0.361, p=0.020) and platelet count (r= -0.585, p=0.000). There was no correlation with admission weight (p=0.125), duration of fever (p=0.387), lowest pulse pressure (p=0.299), ALT(p=0.241), AST(p=0.328), average fluid intake per day (p=0.118) and fluid balance per day (p=0.129). The mean lowest WBC count of 3005/mm3 that was recorded for patients who developed bilateral pleural effusions (n=21) was significantly less (p=0.042) than the mean lowest WBC count of 4091/mm3 that was detected for unilateral effusions (n=12). There was no significant difference in other parameters between these 2 groups. Duration of ascites was significantly positively correlated with highest AST (r=0.598, p=0.002) and highest ALT (r=0.721, p=0.000). CONCLUSION: Severity of body aches on detecting effusions, maximum percentage rise of Hb and PCV, lower WBC and platelet counts seem to be associated with longer periods of TSFA. Among these, lower WBC counts appear to be more predictive of the degree of fluid leakage. Higher ALT and AST levels seem to be useful in predicting the duration of ascites. © 2012 Elsevier Inc.
A study to determine quantitative predictors for development of third space fluid accumulation in adult patients with dengue
(Sri Lanka Medical Association, 2012) Premaratna, R.; Ragupathy, A.; Miththinda, J.K.N.D.; de Silva, H.J.
INTRODUCTION: Prediction of severe illness remains the most important measure in preventing mortality associated with dengue. Increased vascular permeability leading to reduced intravascular volume is the hallmark of dengue shock syndrome. Third space fluid accumulation (TSFA) reflects severe vascular permeability and therefore, it is important to quantitatively identify parameters which predict the occurrence of TSFA in dengue. METHODS:102 patients with confirmed dengue were prospectively followed up for clinical, haematological, biochemical parameters and for evidence of TSFA by serial utrasonography. These parameters were tested against development of TSFA using Receiver Operating Characteristic [ROC] curves to identify quantitative predictors of development of TSFA. RESULTS: 102 patients (52 males) with mean age 28.3 years (SD 11.8), TSFA was detected in 34/95 [36%) after admission; 21/95 developed ascites at mean 5.7 days of illness (SD 1.3) and 33/95 had pleural effusion at 5.4 days (SD 1.5). Onset of TSFA could be identified using percentage rises of highest PCV (p= 0.002) where 6.5% rise of PCV predicted TSFA(sensitivity 61%, specificity 62%)], highest Hb (p=0.017) where rise of 6.1% in Hb predicted TSFA (sensitivity 55%, specificity 64%), lowest recorded platelet count (p<0.000) where platelet count of 48500/mm3 or less predicted TSFA (sensitivity of 83%, specificity 51) post-admission fluid input-output balance per day (p 0.002) where positive balance more than 777cc/day predicted TSFA (sensitivity 65%, specificity 64%). CONCLUSIONS: Rise of PCV and Hb, platelet count, WBC count and daily fluid balance appear to be useful quantitative predictors of TSFA in dengue.
Timing, predictors, and progress of third space fluid accumulation during preliminary phase fluid resuscitation in adult patients with dengue
(Elsevier, 2013) Premaratna, R.; Ragupathy, A.; Miththinda, J.K.N.D.; de Silva, H.J.
BACKGROUND: Fluid leakage remains the hallmark of dengue hemorrhagic fever (DHF). The applicability of currently recommendedpredictors of DHF for adults with dengue is questionable as these are based on studies conducted in children. METHODS: One hundred and two adults with dengue were prospectively followed up to investigate whether home-based or hospital-based early phase fluid resuscitation has an impact on clinical and hematological parameters used for the diagnosis of early or critical phase fluid leakage. RESULTS: In the majority of subjects, third space fluid accumulation (TSFA) was detected on the fifth and sixth days of infection. The quantity and quality of fluids administered played no role in TSFA. A reduction in systolic blood pressure appeared to be more helpful than a reduction in pulse pressure in predicting fluid leakage. TSFA occurred with lower percentage rises in packed cell volume (PCV) than stated in the current recommendations. A rapid reduction in platelets, progressive reduction in white blood cells, percentage rises in Haemoglobin (Hb), and PCV, and rises in aspartate aminotransferase and alanine aminotransferase were observed in patients with TSFA and therefore with the development of severe illness. CONCLUSIONS: Clinicians should be aware of the limitations of currently recommended predictors of DHF in adult patients who are receiving fluid resuscitation
To identify the role of haemoglobin (Hb), pack cell volume (PCV) and pulse pressure (PP) in predicting fluid leakage in patients with dengue who consume adequate amounts of fluids
(Elsevier, 2012) Premaratna, R.; Ragupathy, A.; Miththinda, N.; de Silva, H.J.
BACKGROUND: Early detection of fluid leakage is important in identifying patients who are likely to develop shock syndrome in dengue. As patients with dengue are advised to consume adequate amounts of fluids such behaviours may alter the clinical and haematological parameters predicting fluid leakage. METHODS: In 102 confirmed dengue patients admitted to Professorial Medical Unit, Colombo North Teaching Hospital Ragama from September 2011,quantity and quality of fluids consumed, Hb, PCV, PP and their percentage rise or decline were documented and compared between those who developed and did not develop moderate third space fluid accumulation (3rdSFA) [either pleural effusions, ascites or both detected by ultrasonography. RESULTS: In 102 patients (52 males) with mean (SD) age 28.3 (11.8) years, 3rd SFA was detected in 7/102 (6.8%) on admission and 34/95 (37%) after admission. Compared with those who had 3rdSFA and did not have 3rdSFA at admission; average consumption of water 1044cc/day vs 1091cc/day (p=0.8) and solutes 1050cc/day vs 805cc/day (P=0.26); the mean(SD) Hb 14.7 (2.0) g/dl vs 13.6 (1.8) g/dl (p=0.1); PCV 43.8 (6.5) vs 41.2 (5) (p=0.19); mean pulse pressure 32.8mmHg vs 33.8 (p=0.76). In those who developed 3rdSFA and did not develop 3rdSFA after admission, average consumption of water 620cc/day vs 491cc/day (p=0.14); solutes 1461cc/day vs 1481cc/day (p=0.83); the highest mean (SD) Hb 14.66g/dl (1.82)g/dl vs 14.28 (1.6)g/dl (p=0.3) and highest mean(SD) PCV 44.16 (5.19) vs 43.4 (4.5) (p=0.46); the mean (SD) pulse pressure 29.9mmHg vs 28.4 (p=0.29); The maximum percentage rise in Hb 8% vs 4.6% (p=0.02); PCV 8.6% vs 4.5% (p=0.006); mean pulse pressure drop 6.9% vs 5.9% (p=0.84). CONCLUSION: In the presence of fluid consumption the quality or quantity of fluids consumed did not seems to have played a role in 3rdSFA. A single value of Hb, PCV or pulse pressure was not helpful in predicting early fluid leakage. While percentage reduction in pulse pressure was not helpful, percentage rise in Hb and PCV remained predictive of early fluid leakage in dengue. © 2012 Elsevier Inc.
To identify the role of haemoglobin, pack cell volume and puise pressure in predicting fluid leakage in patients with dengue who consume adequate amounts of fluids
(Sri Lanka Medical Association, 2012) Ranjan, P.; Ragupathy, A.; Miththinda, J.K.N.D.; de Silva, H.J.
INTRODUCTION: Early detection of fluid leakage is important in identifying patients who are likely to develop shock syndrome in dengue. As patients are advised to consume adequate amounts of fluids such behaviours may alter the clinical and haematological parameters predicting fluid leakage. Methods: fn 102 confirmed dengue patients admitted to a single medical unit, CNTH, Ragama from September 2011,quantity and quality of fluids consumed, Hb, PCV, pulse pressure(PP) and their percentage rise or decline were documented and compared between those who developed and did not develop third space fluid accumulation(TSFA) [either pieural effusions, ascites or both detected by ultrasonography]. RESULTS: In 102 patients (52 males) with mean age 28.3(SD=11.8) years, TSFA was detected in 34/95(37%) on follow up. fn those who developed TSFA and did not develop TSFA, average consumption of water 620cc/day vs 491cc/day fp=0.14); solutes 1461cc/day vs 1481cc/day (p=0.83); the mean(SD) values of highest Hb 14.66(1.82)g/dl vs 14.28(1.6)g/dl (p=0.3) and highest PCV 44.16 (5.19) vs 43.4 (4.5) 0=0.46); pulse pressure 29.9mmHg vs 28.4 0=0.29); The maximum percentage rise in Hb 8%vs 4.6% (p=0.02); PCV 8.6% vs 4.5% 0=0-006); mean pulse pressure drop 6.9% vs 5.9% 0=0.84). Conclusions: In the presence of fluid consumption the quality or quantity of fluids consumed did not seems to contribute to TSFA. A single value of Hb, PCV or pulse pressure was not helpful in predicting early fluid leakage. While percentage reduction in pulse pressure was not helpful, percentage rise in Hb and PCV remained predictive of early fluid leakage in dengue.