# Hyperlactatemia, Coagulopathy, and Hepatic Injury as Prognostic Markers of Mortality in Pediatric Dengue: A Single-Center Retrospective Cohort Study

## TL;DR

This study identifies high lactate, coagulopathy, and liver injury as early signs of severe dengue in children, which could help predict mortality risk.

## Contribution

The study introduces specific admission biomarkers (lactate, PT-INR, AST) with cutoffs for predicting mortality in pediatric dengue patients.

## Key findings

- Non-survivors had significantly higher lactate, PT-INR, and AST levels compared to survivors.
- Lactate and PT-INR showed strong individual discriminative ability for predicting mortality.
- Strong positive correlations were observed between lactate, PT-INR, and AST in non-survivors.

## Abstract

Background: Severe dengue has a high mortality rate, especially when identification is delayed. Objective, early laboratory discriminators of mortality could improve triage and resource allocation in pediatric critical care. This study aimed to identify robust admission laboratory discriminators of mortality among children with dengue and to evaluate their individual prognostic performance.

Methodology: We conducted a single-center retrospective observational study of 114 pediatric patients with confirmed dengue infection admitted to the pediatric critical care unit of Tata Main Hospital, Jamshedpur, between June 2023 and December 2023. Admission to the unit followed a uniform institutional protocol based on World Health Organization (WHO) guidelines. Demographic, clinical, and laboratory data (including lactate levels, coagulation profiles, and liver enzymes) were extracted from electronic records. Statistical analyses included the Mann-Whitney U test for continuous variables, Fisher’s exact test for categorical variables, Spearman’s correlation, and receiver operating characteristic (ROC) analysis.

Results: Non-survivors (n = 15, 13.15%) had significantly higher lactate (13.6 vs. 3.0 mmol/L, P < 0.001), prothrombin time-international normalized ratio (PT-INR) (2.48 vs. 1.25, P < 0.001), and aspartate aminotransferase (AST) (1185.0 vs. 215.4 U/L, P = 0.003) compared to survivors. ROC analysis demonstrated strong individual discriminative ability: lactate AUC = 0.941 (95% confidence interval (CI): 0.898-0.984), PT-INR AUC = 0.918 (0.865-0.971), AST AUC = 0.743 (0.602-0.884). Data-driven Youden cutoffs were as follows: lactate ≥6.6 mmol/L (sensitivity 93.3%, specificity 90.9%), PT-INR ≥1.855 (sensitivity 86.7%, specificity 89.9%), and AST ≥841.5 U/L (sensitivity 73.3%, specificity 78.8%). Strong positive correlations were observed between these parameters (lactate vs. PT-INR: ρ = 0.585, P < 0.001).

Conclusions: Hyperlactatemia, coagulopathy, and hepatocellular injury are significantly correlated with mortality in dengue, with lactate and PT-INR demonstrating particularly robust individual discriminative capabilities. These readily available biomarkers may help identify high‑risk patients early, but the proposed cutoffs require prospective multicenter validation before routine integration into dengue management protocols.