Clinical Scorecard: Chronic Subclinical Inflammation and Long-term Functional and Cognitive Effects Following Dengue Shock and Septic Shock in Vietnam

At a Glance

Key Highlights

• Survivors of dengue shock showed mild cognitive impairment at discharge that normalized by 3 months; survivors of septic shock had persistent cognitive impairment up to 6 months.
• Both dengue shock and septic shock survivors exhibited elevated inflammatory markers (IL-6, ferritin) up to 6 months post-discharge compared to healthy controls.
• No significant persistent endothelial activation was observed despite ongoing inflammation.

Guideline-Based Recommendations

Diagnosis

• Use WHO (2009) criteria for dengue shock and Sepsis 3 definitions for septic shock diagnosis.
• Assess cognitive function post-discharge using Montreal Cognitive Assessment (MoCA).
• Measure health-related quality of life with EQ-5D-5L at discharge and follow-up.

Management

• Monitor survivors of dengue and septic shock for persistent inflammation and cognitive impairment.
• Consider longitudinal follow-up for functional and cognitive recovery up to at least 6 months post-discharge.
• No current evidence supports endothelial-targeted therapies post-discharge due to lack of persistent endothelial activation.

Monitoring & Follow-up

• Serial measurement of plasma inflammatory biomarkers (IL-6, ferritin, CRP) at discharge, 1, 3, and 6 months.
• Evaluate endothelial function using EndoPAT reactive hyperemia index (RHI) at similar intervals.
• Assess cognitive function and quality of life longitudinally to guide rehabilitation needs.

Risks

• Persistent subclinical inflammation may contribute to long-term morbidity.
• Septic shock survivors are at higher risk of prolonged cognitive impairment compared to dengue shock survivors.
• Lack of routine post-discharge follow-up and rehabilitation programs in Vietnam may delay identification and management of sequelae.

Patient & Prescribing Data

Adult survivors of dengue shock and septic shock in a low-middle income country setting (Vietnam).

Persistent inflammation despite clinical recovery suggests potential need for targeted interventions; cognitive impairment recovery differs between dengue and septic shock survivors.

Clinical Best Practices

• Implement structured post-discharge follow-up programs for infectious shock survivors to monitor inflammation, cognitive function, and quality of life.
• Use validated tools such as MoCA and EQ-5D-5L for standardized assessment of cognitive and functional outcomes.
• Recognize that endothelial dysfunction may not persist beyond acute phase, focusing management on inflammation and cognitive rehabilitation.
• Tailor rehabilitation and support services considering differing recovery trajectories between dengue shock and septic shock survivors.

References

• World Health Organization Dengue Guidelines 2009
• Sepsis-3 Definitions
• Montreal Cognitive Assessment (MoCA)
• EQ-5D-5L Health-Related Quality of Life Instrument
• EndoPAT Device for Endothelial Function