Arya Krisna Manggala, Justika Usmadhani Aulya, Jonny Karunia Fajar, Dyah Kanya Wati
Background: Dengue shock syndrome (DSS) continues to have high morbidity and mortality among Indonesian children. In addition, studies on the risk factors for DSS among children, particularly in Indonesia, remain inconsistent and inconclusive. Thus, we conducted a recent systematic review and meta-analysis of the risk factors associated with DSS. Methods: Published papers from PubMed, Google Scholar, Garba Rujukan Digital (GARUDA), and the Indonesian Scientific Journal Database (ISJD) assessing demographic aspects, clinical manifestations, and laboratory findings were analyzed. Pooled odds ratios (OR) or event rates with 95 % confidence intervals (CI) were estimated using fixed or random-effects models. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Results: We included 19 studies with a total of 3086 children, reporting the event rate and the risk factors associated with DSS in children. The pooled rate showed that 36.0 % of children in Indonesia had DSS (PR 0.36 [95 % CI 0.33–0.38], p < 0.001). Pooled OR identified that obesity/overweight (OR 2.30 [95 % CI 1.51–3.48], p < 0.001), secondary dengue infection (OR 1.49 [95 % CI 1.12–1.99], p = 0.006), abdominal pain (OR 2.34 [95 % CI 1.29–4.25], p = 0.005), hepatomegaly (OR 6.31 [95 % CI 2.78–14.31], p < 0.001), ascites (OR 9.56 [95 % CI 6.27–14.59], p < 0.001), pleural effusion (OR 9.15 [95 % CI 3.18–26.29], p < 0.001), gastrointestinal tract (GI) bleeding (OR 5.15 [95 % CI 1.87–14.13], p = 0.001), increased hematocrit (OR 4.65 [95 % CI 2.95–7.34], p < 0.001), thrombocytopenia (OR 3.21 [95 % CI 1.81–5.69], p < 0.001), and elevated aspartate aminotransferase (AST) levels (OR 7.42 [95 % CI 4.02–13.69], p < 0.001) were significant risk factors associated with DSS in children. Conclusion: Obesity/overweight, secondary dengue infection, abdominal pain, hepatomegaly, ascites, pleural effusion, gastrointestinal tract bleeding, increased hematocrit, thrombocytopenia, and elevated AST levels were identified as risk factors for DSS among Indonesian children. © 2025 The Authors
Department of Child Health, Faculty of Medicine Universitas Udayana, Ngoerah Hospital, Bali, 80232, Indonesia; Faculty of Medicine, Universitas Sumatera Utara, Medan, 20155, Indonesia; Brawijaya Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, East Java, Malang, 65145, Indonesia; Pediatric Emergency and Intensive Care Medicine Division, Department of Child Health, Faculty of Medicine Universitas Udayana, Ngoerah Hospital, Bali, 80232, Indonesia
