Abstract

Introduction: Thrombocytopenia and bleeding are common complications of dengue
fever. Platelet count is a poor predictor of bleeding manifestations. A surrogate marker
of bleeding can be D-Dimer assay which is often used to describe coagulation activity in
a patient. This project aims to study the correlation of D-dimer level with coagulation
parameters so that d-dimer assay can be considered as an important predictor and
prognostic marker for development of hemorrhage or shock in dengue.
Methodology: This was a cross sectional study done on dengue patients attending
Gandhi hospital from 2019 to 2021. Patients were grouped in to 2 groups – group1
having no bleeding manifestations and group 2 having bleeding manifestations. D-dimer
levels in both groups were compared with platelet count, aPTT, PT and INR. Means of
both groups were compared using student’s unpaired t-test. p value of <0.05 was taken
as significant. Correlation of d-dimer with thrombocytopenia and coagulation
parameters was done using Pearson’s correlation
Results: 100 patients were recruited in this study. Of these 100, 57 patients did not have
any bleeding manifestation and 43 had bleeding manifestations. Mean age in group 1
was 40.60±16.14 and in group 2 was 38.95±15.60. Group 1 had 23 (40.35%) females and
group 2 had 17 (39.53%) females. Mean platelet count in group 1 was
72,263.16±26,340.85 /ul while in group 2 was 54,813.95±16,844.18 /ul. Mean APTT in
group 1 was 36.65±2.02 seconds while in group 2 was 37.67±2.22 seconds. Mean APTT
in group 1 was 36.65±2.02 seconds while in group 2 was 37.67±2.22 seconds. Mean PT in
group 1 was 15.46±1.49 seconds while in group 2 was 16.16±1.79 seconds. Mean INR in
group 1 was 1.41±0.14 while in group 2 was 1.80±0.20. Mean D-Dimer in group 1 was
929.74±268.46 ng/ml while in group 2 was 5034.53±2024.85 ng/ml. All parameters were
significantly higher in group with bleeding compared to non-bleeding (p>0.05). D dimer
had positive correlation with thrombocytopenia, APTT, PT and INR. Association of d
dimer with APTT, PT and INR was higher in bleeding group.
Conclusion: D-dimer levels were raised in dengue patients with bleeding. Strong
association of d-dimer levels with thrombocytopenia, APTT, PT and INR was seen in
both groups. Hence it can be concluded that detection of D dimer in febrile stage of
dengue infection may be beneficial for predicting the clinical course of the disease