1921
Volume 100, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

According to the World Health Organization, 98% of fatal dengue cases can be prevented; however, endemic countries such as Colombia have recorded higher case fatality rates during recent epidemics. We aimed to identify the predictors of mortality that allow risk stratification and timely intervention in patients with dengue. We conducted a hospital-based, case–control (1:2) study in two endemic areas of Colombia (2009–2015). Fatal cases were defined as having either 1) positive serological test (IgM or NS1), 2) positive virological test (RT-PCR or viral isolation), or 3) autopsy findings compatible with death from dengue. Controls (matched by state and year) were hospitalized nonfatal patients and had a positive serological or virological dengue test. Exposure data were extracted from medical records by trained staff. We used conditional logistic regression (adjusting for age, gender, disease’s duration, and health-care provider) in the context of multiple imputation to estimate exposure to case–control associations. We evaluated 110 cases and 217 controls (mean age: 35.0 versus 18.9; disease’s duration pre-admission: 4.9 versus 5.0 days). In multivariable analysis, retro-ocular pain (odds ratios [OR] = 0.23), nausea (OR = 0.29), and diarrhea (OR = 0.19) were less prevalent among fatal than nonfatal cases, whereas increased age (OR = 2.46 per 10 years), respiratory distress (OR = 16.3), impaired consciousness (OR = 15.9), jaundice (OR = 32.2), and increased heart rate (OR = 2.01 per 10 beats per minute) increased the likelihood of death (AUC: 0.97, 95% confidence interval: 0.96, 0.99). These results provide evidence that features of severe dengue are associated with higher mortality, which strengthens the recommendations related to triaging patients in dengue-endemic areas.

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References

  1. Bhatt S et al., 2013. The global distribution and burden of dengue. Nature 496: 504507.
    [Google Scholar]
  2. Qian M-B, Zhou X-N, 2016. Global burden on neglected tropical diseases. Lancet Infect Dis 16: 11131114.
    [Google Scholar]
  3. Wilson ME, Chen LH, 2015. Dengue: update on epidemiology. Curr Infect Dis Rep 17: 457.
    [Google Scholar]
  4. World Health Organization. Dengue and Severe Dengue. Available at: www.who.int/mediacentre/factsheets/fs117/en/index.html. Accessed March 7, 2017.
  5. Tomashek KM et al., 2016. Enhanced surveillance for fatal dengue-like acute febrile illness in Puerto Rico, 2010–2012. PLoS Negl Trop Dis 10: e0005025.
    [Google Scholar]
  6. Moraes GH, de Fátima Duarte E, Duarte EC, 2013. Determinants of mortality from severe dengue in Brazil: a population-based case-control study. Am J Trop Med Hyg 88: 670676.
    [Google Scholar]
  7. Liew SM et al., 2016. Dengue in Malaysia: factors associated with dengue mortality from a national registry. PLoS One 11: 114.
    [Google Scholar]
  8. GBD 2015 Mortality and Causes of Death Collaborators, 2016. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388: 14591544.
    [Google Scholar]
  9. Rosso F, Vanegas S, Rodríguez S, Pacheco R, 2016. Prevalencia y curso clínico de la infección por dengue en adultos mayores con cuadro febril agudo en un hospital de alta complejidad en Cali, Colombia. Biomédica 36: 179.
    [Google Scholar]
  10. Chaparro P, León W, Castañeda CA, 2016. Comportamiento de la mortalidad por dengue en Colombia entre 1985 y 2012. Biomédica 36: 125.
    [Google Scholar]
  11. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators, 2016. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388: 15451602.
    [Google Scholar]
  12. Gamakaranage C, Rodrigo C, Samarawickrama S, Wijayaratne D, Jayawardane M, Karunanayake P, Jayasinghe S, 2012. Dengue hemorrhagic fever and severe thrombocytopenia in a patient on mandatory anticoagulation; balancing two life threatening conditions; a case report. BMC Infect Dis 12: 272.
    [Google Scholar]
  13. Pang J, Hsu JP, Yeo TW, Leo YS, Lye DC, 2017. Diabetes, cardiac disorders and asthma as risk factors for severe organ involvement among adult dengue patients: a matched case-control study. Sci Rep 7: 39872.
    [Google Scholar]
  14. Carabali M, Hernandez LM, Arauz MJ, Villar LA, Ridde V, 2015. Why are people with dengue dying? A scoping review of determinants for dengue mortality. BMC Infect Dis 15: 301.
    [Google Scholar]
  15. World Health Organization, 2012. Global Strategy for Dengue Prevention and Control 2012–2020. Geneva, Switzerland: WHO Library Cataloguing-in-Publication Data.
    [Google Scholar]
  16. Khan MIH, Anwar E, Agha A, Hassanien NSM, Ullah E, Syed IA, Raja A, 2013. Factors predicting severe dengue in patients with dengue fever. Mediterr J Hematol Infect Dis 5: e2013014.
    [Google Scholar]
  17. Yacoub S, Wills B, 2014. Predicting outcome from dengue. BMC Med 12: 147.
    [Google Scholar]
  18. Bhaskar E, Sowmya G, Moorthy S, Sundar V, 2015. Prevalence, patterns, and factors associated with bleeding tendencies in dengue. J Infect Dev Ctries 9: 105110.
    [Google Scholar]
  19. Ong A, Sandar M, Chen MI, Sin LY, 2007. Fatal dengue hemorrhagic fever in adults during a dengue epidemic in Singapore. Int J Infect Dis 11: 263267.
    [Google Scholar]
  20. World Health Organization, Special Programme for Research and Training in Tropical Diseases, 2009. Dengue: Guidelines for Diagnosis, Treatment, Prevention, and Control. Geneva, Switzerland: WHO Press.
    [Google Scholar]
  21. World Health Organisation, 1997. Dengue Haemorrhagic Fever: Diagnosis, Treatment, Prevention and Control, 2nd edition, Vol. 40. Geneva, Switzerland: WHO, 103117.
    [Google Scholar]
  22. Van Buuren S, 2007. Multiple imputation of discrete and continuous data by fully conditional specification. Stat Methods Med Res 16: 219242.
    [Google Scholar]
  23. Rubin DB, 1987. Multiple Imputation for Nonresponse in Surveys. Hoboken, NJ: John Wiley & Sons, Inc.
    [Google Scholar]
  24. Thein TL, Leo YS, Fisher DA, Low JG, Oh HML, Gan VC, Wong JGX, Lye DC, 2013. Risk factors for fatality among confirmed adult dengue inpatients in Singapore: a matched case-control study. PLoS One 8: e81060.
    [Google Scholar]
  25. Ooi EE, Goh KT, Chee Wang DN, 2003. Effect of increasing age on the trend of dengue and dengue hemorrhagic fever in Singapore. Int J Infect Dis 7: 231232.
    [Google Scholar]
  26. Guzmán MG, Alvarez M, Rodríguez R, Rosario D, Vázquez S, Valdés L, Cabrera MV, Kourí G, 1999. Fatal dengue hemorrhagic fever in Cuba, 1997. Int J Infect Dis 3: 130135.
    [Google Scholar]
  27. Zagne SMO, Alves VGF, Nogueira RMR, Miagostovich MP, Lampe E, Tavares W, 1994. Dengue haemorrhagic fever in the state of Rio de Janeiro, Brazil: a study of 56 confirmed cases. Trans R Soc Trop Med Hyg 88: 677679.
    [Google Scholar]
  28. Lee IK, Liu JW, Yang KD, 2008. Clinical and laboratory characteristics and risk factors for fatality in elderly patients with dengue hemorrhagic fever. Am J Trop Med Hyg 79: 149153.
    [Google Scholar]
  29. Karunakaran A, Ilyas WM, Sheen SF, Jose NK, Nujum ZT, 2014. Risk factors of mortality among dengue patients admitted to a tertiary care setting in Kerala, India. J Infect Public Health 7: 114120.
    [Google Scholar]
  30. Lee IK, Liu JW, Yang KD, 2012. Fatal dengue hemorrhagic fever in adults: emphasizing the evolutionary pre-fatal clinical and laboratory manifestations. PLoS Negl Trop Dis 6: e1532.
    [Google Scholar]
  31. Kuo MC, Lu PL, Chang JM, Lin MY, Tsai JJ, Chen YH, Chang K, Chen HC, Hwang SJ, 2008. Impact of renal failure on the outcome of dengue viral infection. Clin J Am Soc Nephrol 3: 13501356.
    [Google Scholar]
  32. Silva H, Hernandez-Hernandez R, Vinueza R, Velasco M, Boissonnet CP, Escobedo J, Silva HE, Pramparo P, Wilson E; CARMELA Study Investigators, 2010. Cardiovascular risk awareness, treatment, and control in urban Latin America. Am J Ther 17: 159166.
    [Google Scholar]
  33. Wang CC, Liu SF, Liao SC, Lee IK, Liu JW, Lin AS, Wu CC, Chung YH, Lin MC, 2007. Acute respiratory failure in adult patients with dengue virus infection. Am J Trop Med Hyg 77: 151158.
    [Google Scholar]
  34. Campos KB, Amâncio FF, de Araújo VEM, Carneiro M, 2015. Factors associated with death from dengue in the state of Minas Gerais, Brazil: historical cohort study. Trop Med Int Health 20: 211218.
    [Google Scholar]
  35. Pang J, Thein TL, Leo YS, Lye DC, 2014. Early clinical and laboratory risk factors of intensive care unit requirement during 2004–2008 dengue epidemics in Singapore: a matched case-control study. BMC Infect Dis 14: 649.
    [Google Scholar]
  36. Alexander N et al., European Union, World Health Organization (WHO–TDR) supported DENCO Study Group, 2011. Multicentre prospective study on dengue classification in four south-east Asian and three Latin American countries. Trop Med Int Health 16: 936948.
    [Google Scholar]
  37. Westreich D, 2012. Berkson’s bias, selection bias, and missing data. Epidemiology 23: 159164.
    [Google Scholar]
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  • Received : 18 Apr 2017
  • Accepted : 14 Aug 2018
  • Published online : 14 Jan 2019
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