An optimal risk score for early plasma leakage prediction in adult dengue patients: A multicenter study

Delay in recognition of plasma leakage may result in inappropriate fluid management, potentially leading to fluid overload, shock dengue, organ dysfunction, and death. We aimed to develop simple clinical scoring systems to early predict plasma leakage in adult dengue patients.

This prospective observational cohort study was conducted at five hospitals in Vietnam from September 2024 to September 2025. Hospitalized dengue adults (age ≥18 years) with fever onset ≤ 5 days, without plasma leakage at admission, were included for analysis. Demographic characteristics, lifestyle factors, pre-hospital treatment, and clinical symptoms were collected from a questionnaire, while laboratory parameters were extracted from medical records. We employed stepwise multivariate logistic regression analysis with a backward selection method and receiver operating characteristic (ROC) curve analysis to develop and validate the score.

Of 774 confirmed dengue patients, 161 (20.8 %) developed plasma leakage. Multivariate analysis revealed four independent factors associated with a higher risk of plasma leakage, including fluid infusion before admission (aOR = 1.931, 95 % CI = 1.169-3.191, p = 0.010), low physical activity (aOR = 1.711, 95 % CI = 1.034-2.831, p = 0.037), AST ≥ 80 IU/L (aOR=3.230, 95 % CI= 1.989-5.247, p < 0.001) and sodium < 135 mmol/L (aOR= 1.936, 95 % CI=1.191-3.145, p = 0.008). The plasma leakage score (PLS) demonstrated good discriminatory ability, with an AUC of 0.693 (95 % CI: 0.636-0.750; p < 0.001). A cut-off of 2 yields a sensitivity of 82.4 %, a specificity of 46.8 % and a negative predictive value of 90.1 % for predicting plasma leakage.

This clinical and practical score could assist physicians in determining patients with a higher likelihood of developing plasma leakage during hospitalization, particularly in endemic, remote, and resource-limited settings.