D engue is an arthropod borne viral disease which has a huge impact on human health as well as the global and national economies. It is widespread throughout the tropics, with local variations in risk influenced by rainfall, temperature, relative humidity, and unplanned rapid urbanization [1]. A total of 390 million dengue virus infections occur per year of which 96 million manifests clinically with varying severity [2] . A study on the prevalence of dengue estimates that 3.9 billion people are

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... at risk of infection with dengue viruses. Despite a risk of infection existing in 129 countries [3], 70% of the actual burden is in Asia [2] . In 2020, dengue continues to affect several countries, with reports of increase in the numbers of cases in number of countries including India. Bhatt et al. showed a discrepancy between reported and modeled dengue incidence, which was particularly high for India. According to their estimates, India contributed 34 of 96 million apparent global dengue infections, a number which stands in stark contrast to the 12,484 reported cases from India to the World Health Organization (WHO) in the same year. Such a mismatch was also reported for India in another study, in which the actual numbers of dengue cases were 282 times the number reported by the national vector-borne disease control program [4] . Dengue is a systemic and dynamic disease. After the incubation period, the illness begins abruptly and is followed by the three phases; febrile, critical, and recovery phase [5]. The WHO classifies dengue into two major categories: Dengue (with/ without warning signs) and severe dengue. This subclassification ABSTRACT Background: Dengue is an emerging arthropod borne disease with increasing incidence in recent years in several countries, especially India. Early recognition of progression of disease helps in triage and timely management of fluids to decrease mortality. Objective: The objective of the study was to identify the predictive factors for severe dengue in pediatric patients for hospitalization for close monitoring. Methods: This was a prospective observational study conducted in the department of pediatrics in a tertiary care hospital in Mahbubnagar from June 2019 to May 2020. One hundred and four children between the age group of 0 and 15 years with probable dengue symptoms who were willing to get admitted were included in the study cohort. Thorough history and clinical examination, basic laboratory investigations such as complete blood picture, hematocrit, liver function tests, renal function tests (RFTs), serum electrolytes, serum ferritin, and coagulation profile were done as needed. All the patients were grouped into two groups -non-severe dengue (dengue fever without warning signs and dengue fever with warning signs) and severe dengue as per the World Health Organization guidelines. All the variables were analyzed using SPSS software. Results: Out of 104 confirmed cases, majority of the admissions were in 5-10 years age group (51.9%). Male children were 61.5%. Mean duration of hospitalization was 4.79±2.96 days. Fever (97.1%) was the most common symptom followed by anorexia (86.5%) and lethargy (82.7%). Symptoms such as lethargy, vomiting, abdominal pain/epigastric tenderness, epistaxis, edema, and altered sensorium were more commonly associated with severe dengue. Hepatomegaly (53.9%) was the most common clinical sign followed by epigastric tenderness (58.7%). Hepatomegaly, splenomegaly, ascites, gallbladder edema, pleural effusion, low pulse pressure, hypotension, oliguria, and significant gastrointestinal bleeds were more common in severe dengue group. Platelet count <50,000/mm 3 , increase in hematocrit more than 20% from baseline, raised transaminases, raised ferritin, decrease in serum sodium, decrease in serum albumin, abnormal coagulation profile, and abnormal RFTs were significantly associated with severe dengue. Mean platelet recovery time was 3-5 days. Conclusion: Dengue is a dynamic disease and progression of dengue with or without warning signs into severe dengue can be appropriately identified by close monitoring of certain clinical signs and symptoms.