Imperial College London


Faculty of MedicineDepartment of Immunology and Inflammation

Visiting Professor



+44 (0)20 7594 1190g.screaton Website




Ms Claire Puddephatt +44 (0)20 7594 1190




2.15Faculty BuildingSouth Kensington Campus






BibTex format

author = {Yacoub, S and Trieu, HT and Phung, KL and Vuong, HNT and Duong, HTH and Tu, QP and Oanh, PKN and Nguyen, THQ and Simmons, CP and Broyd, C and Screaton, GR and Wills, B},
doi = {10.1371/journal.pntd.0005740},
title = {Cardio-haemodynamic assessment and venous lactate in severe dengue: Relationship with recurrent shock and respiratory distress},
url = {},
volume = {11},
year = {2017}

RIS format (EndNote, RefMan)

AB - BackgroundDengue can cause plasma leakage that may lead to dengue shock syndrome (DSS). In approximately 30% of DSS cases, recurrent episodes of shock occur. These patients have a higher risk of fluid overload, respiratory distress and poor outcomes. We investigated the association of echocardiographically-derived cardiac function and intravascular volume parameters plus lactate levels, with the outcomes of recurrent shock and respiratory distress in severe dengue.Methods/Principle findingsWe performed a prospective observational study in Paediatric and adult ICU, at the Hospital for Tropical Diseases (HTD), Ho Chi Minh City, Vietnam. Patients with dengue were enrolled within 12 hours of admission to paediatric or adult ICU. A haemodynamic assessment and portable echocardiograms were carried out daily for 5 days from enrolment and all interventions recorded.102 patients were enrolled; 22 patients did not develop DSS, 48 had a single episode of shock and 32 had recurrent shock. Patients with recurrent shock had a higher enrolment pulse than those with 1 episode or no shock (median: 114 vs. 100 vs. 100 b/min, P = 0.002), significantly lower Stroke Volume Index (SVI), (median: 21.6 vs. 22.8 vs. 26.8mls/m2, P<0.001) and higher lactate levels (4.2 vs. 2.9 vs. 2.2 mmol/l, P = 0.001). Higher SVI and worse left ventricular function (higher Left Myocardial Performance Index) on study days 3–5 was associated with the secondary endpoint of respiratory distress. There was an association between the total IV fluid administered during the ICU admission and respiratory distress (OR: 1.03, 95% CI 1.01–1.06, P = 0.001). Admission lactate levels predicted patients who subsequently developed recurrent shock (P = 0.004), and correlated positively with the total IV fluid volume received (rho: 0.323, P = 0.001) and also with admission ALT (rho: 0.764, P<0.001) and AST (rho: 0.773, P<0.001).Conclusions/SignificanceEcho-derived intravascular volume assessment and venou
AU - Yacoub,S
AU - Trieu,HT
AU - Phung,KL
AU - Vuong,HNT
AU - Duong,HTH
AU - Tu,QP
AU - Oanh,PKN
AU - Nguyen,THQ
AU - Simmons,CP
AU - Broyd,C
AU - Screaton,GR
AU - Wills,B
DO - 10.1371/journal.pntd.0005740
PY - 2017///
SN - 1935-2735
TI - Cardio-haemodynamic assessment and venous lactate in severe dengue: Relationship with recurrent shock and respiratory distress
UR -
UR -
UR -
VL - 11
ER -