Adjunctive corticosteroid therapy in 149 grade II (non-shock) adult DHF patients: an analysis during January 2008-February 2010.

Background: It is well known that immunopathogenesis play an important role in the development of severe complications in DHF. Since 2006, the authors have experience in giving immunomodulators to save life of many severe complicated adult DHF patients. This experience stimulates our interest on the benefit of adjunctive corticosteroid therapy in adult grade II DHF patients.

Objective: To find out whether there are some benefits of giving adjunctive corticosteroid therapy in adult grade II DHF patients.

Design Of The Study: Retrospective analysis during January 2008-February 2010.

Material And Method: One hundred and forty nine adult grade II DHF patients were admitted at Vichaiyut Hospital. They were divided into 3 groups according to the different therapy designed by the responsible clinicians. Group 1 consisted of 59 cases who received full dose-short course of intravenous dexamethasone (4 milligram every 6 hours for 2-3 days). Group 2 consisted of 61 cases who received intermittent 4 milligrams intravenous dexamethasone only at febrile episode and group 3-29 cases did not received corticosteroid. All the patients were investigated similarly. Age, sex, symptoms and signs including daily hematologic studies (Hct, Wbc, differential count, platelet count) were recorded. Serum SGOT SGPT bilirubin, alkaline phosphatase and albumin BUN, creatinine were performed on admission and repeated as indicated. The parameter to measure the benefit of adjunctive corticosteroid included 1) severity of thrombocytopenia, 2) liver impairment, 3) the days of illness as determined by fever and 4) the length of the hospital days.

Results: The clinical severity of all the three groups were quite similar. There was no benefit of using adjunctive corticosteroid therapy in term of changing the severity of thrombocytopenia and liver impairment. However, the days of illness and the length of hospital days were shorter at 4.6 days and 3.7 days respectively in the group who received full dose, continuous-short course of dexamethasone intravenously. This is statistically significant when compared to the other two groups who had the longer total days of fever at 5.8 days and 6.03 days and the longer length of hospital days at 5.19 days and 4.5 days respectively (p < 0.05).

Conclusion: Adjunctive corticosteroid by given full dose, continuous short course in grade II adult DHF reduced the course of illness (days of fever) and the length of hospital days. These findings indicated the benefit of using adjunctive corticosteroid therapy in grade II adult DHF patients.