# Capillary Leakage on Ultrasound in Children with Dengue

## TL;DR

This study shows that ultrasound is highly effective at detecting capillary leakage in children with dengue, especially in school-age and adolescent patients with liver involvement.

## Contribution

The study demonstrates the high sensitivity of ultrasound for detecting capillary leakage in pediatric dengue patients.

## Key findings

- Ultrasound detected capillary leakage in 95.5% of children with dengue.
- School-age/adolescent children and elevated liver enzymes were strongly associated with capillary leakage.
- Thrombocytopenia and hypoalbuminemia were common in patients with capillary leakage.

## Abstract

Background/Objectives: Dengue is one of the leading causes of morbidity in children in endemic regions. Capillary leakage is the pathophysiological hallmark of severe dengue, and ultrasound has established as a sensitive tool for its early detection. However, evidence in the pediatric population remains limited. The aim of this study was to identify the presence of capillary leakage detected by ultrasound and its associations in children with dengue. Methods: Observational/descriptive/cross-sectional/retrospective study conducted in patients between 6 months and 14 years old with confirmed dengue and warning signs or severe dengue, treated at the Hospital Universitario del Valle in Cali, Colombia, between July 2019 and June 2020. Ultrasound examinations were performed and interpreted by radiologists following an institutional standardized protocol. Associations with capillary leakage were evaluated using the chi-square test and their respective OR and 95% CI. Results: A total of 132 children were included. Ultrasound capillary leakage was identified in 95.5%, mainly ascites (83.3%), pleural effusion (46.2%), hepatomegaly (40.9%), and vesicular thickening (39.4%). Associated factors were belonging to school/adolescent group (OR = 13.52; 95% CI = 1.41–646.51; p = 0.0031), elevated alanine aminotransferase (OR = 11.06; 95% CI = 1.32–94.82; p = 0.0007), and aminotransferase levels grades C–D (OR = 6.87; 95% CI = 0.82–54.59; p = 0.0110). Thrombocytopenia and hypoalbuminemia were common. Three deaths (0.9%) occurred in the initially confirmed cohort prior to ultrasound-based inclusion, all of whom presented multiple risk factors for capillary leakage. Conclusions: In this cohort ultrasound showed high sensitivity for detecting capillary leakage in pediatric dengue and was associated with school-age/adolescents and liver involvement. Its systematic use could improve early identification of severe forms and optimize clinical management in resource-limited settings.