Nutrition outperforms platelet counts in predicting prolonged hospital stays for children with dengue

A study in Yogyakarta found that underweight, overweight and obese children with dengue were more likely to stay in hospital for more than four days, while platelet measures added little predictive value.

A study from Yogyakarta, Indonesia, suggests that a child’s nutritional status may be a better guide to prolonged dengue hospitalisation than the platelet measures doctors have long watched most closely. In BMC Paediatrics, researchers at Dr Sardjito General Hospital reported that children with dengue who were undernourished, or who were overweight or obese, were more likely to stay in hospital for more than four days than those with healthier weight profiles. The findings come from a retrospective cohort study of paediatric dengue admissions between 2019 and 2024 and point to length of stay as a practical marker of illness burden and hospital resource use.

The team reviewed 104 children who met its inclusion criteria, with 102 survivors entering the analysis of prolonged stay. Of those, 32 children, or 31.4%, remained in hospital for more than four days. Investigators compared nutritional status with several platelet measures, including platelet count and platelet indices such as mean platelet volume, platelet distribution width, plateletcrit and platelet large cell ratio, as well as clinical warning signs. In multivariable analysis, nutritional status stood out as the only robust independent predictor, while platelet count, the other platelet markers and warning signs did not show the same signal.

The study also tested how well three prediction models performed: one built around platelet variables, one based on nutrition alone and one combining both sets of factors. The platelet-only model performed poorly, with little ability to distinguish between children who would or would not remain in hospital beyond four days. By contrast, the nutrition-only model and the full model both showed better discrimination, although their performance was more modest after internal cross-validation. Even then, the added value of platelet measures beyond nutritional status was small, suggesting that the older habit of focusing on platelet numbers may offer limited help in this specific outcome.

That interpretation fits with older and broader dengue research, although the evidence has not always been consistent. A separate study in BMC Infectious Diseases found that the relationship between malnutrition and dengue severity was controversial and not statistically clear across the available data. At the same time, other research has challenged the usefulness of platelet counts as a stand-alone guide in dengue. A study in PLOS Neglected Tropical Diseases reported that daily platelet counts did not predict dengue shock syndrome in Vietnamese children, while a review in Transfusion Medicine noted that platelet levels often correlate poorly with bleeding or severity in children and should not automatically trigger transfusion. Taken together, those findings support a more cautious reading of platelet values than many clinicians have traditionally used.

The Indonesian study still has limits. It was conducted in a single referral hospital, so the results may not apply neatly to other settings, and the performance estimates came from internal validation rather than testing in an independent population. The authors also said the findings should be adjusted further for disease severity before any clinical use. Even so, the study adds to a growing body of work suggesting that, in paediatric dengue, nutritional status may matter more than platelet counts when the practical question is which children are likely to occupy a hospital bed for longer.