Albumin Infusion in Children With Fluid Refractory Severe Dengue: A Comparative Study

Area of Science:

• Pediatrics
• Infectious Diseases
• Critical Care Medicine

Background:

• Severe dengue is a significant cause of morbidity and mortality in children.
• Fluid refractory shock in severe dengue requires effective therapeutic interventions.
• Standard treatment (ST) protocols may not always be sufficient for managing severe dengue complications.

Purpose of the Study:

• To evaluate the efficacy of 25% albumin combined with ST versus ST alone in pediatric patients with fluid-refractory severe dengue.
• To compare morbidity and mortality rates between the two treatment groups.

Main Methods:

• A comparative study involving children aged 2 months to 18 years with severe dengue.
• Two groups were formed: ST-plus albumin (prospective) and ST-only (retrospective).
• Patients in circulatory shock received initial fluid resuscitation before group allocation; albumin was administered at 0.5-1 g/kg in the ST-plus albumin group.

Main Results:

• Survival was significantly higher in the ST-plus albumin group (97.1%) compared to the ST-only group (77.1%) (P=0.043).
• The need for inotropic support, bleeding, acute kidney injury (AKI), diuretics, and renal replacement therapy were all significantly lower in the ST-plus albumin group.
• P-values for these outcomes were P<0.001 for inotropes, P=0.008 for bleeding, P=0.065 for AKI, P=0.029 for diuretics, and P=0.028 for renal replacement therapy.

Conclusions:

• Early administration of 25% albumin to children with fluid-refractory severe dengue improves survival rates.
• Albumin supplementation reduces fluid accumulation, bleeding incidence, and the occurrence of complications such as AKI.
• This therapeutic strategy offers a significant benefit in managing severe dengue in pediatric populations.