Mortality among Hospitalized Dengue Patients with Comorbidities in Mexico, Brazil, and Colombia

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  • 1 Área De Microbiología, Departamento De Medicina y Nutrición, Universidad de Guanajuato, Guanajuato, Mexico;
  • 2 Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil;
  • 3 Los Andes University, Bogota, Colombia;
  • 4 Sanofi Pasteur, Lyon, France;
  • 5 Ariana Pharmaceuticals, Paris, France;
  • 6 Sanofi Pasteur, Mexico City, Mexico

Dengue patients with comorbidities may be at higher risk of death. In this cross-sectional study, healthcare databases from Mexico (2008–2014), Brazil (2008–2015), and Colombia (2009–2017) were used to identify hospitalized dengue cases and their comorbidities. Case fatality rates (CFRs), relative risk, and odds ratios (OR) for in-hospital mortality were determined. Overall, 678,836 hospitalized dengue cases were identified: 68,194 from Mexico, 532,821 from Brazil, and 77,821 from Colombia. Of these, 35%, 5%, and 18% were severe dengue, respectively. Severe dengue and age ≥ 46 years were associated with increased risk of in-hospital mortality. Comorbidities were identified in 8%, 1%, and 4% of cases in Mexico, Brazil, and Colombia, respectively. Comorbidities increased hospitalized dengue CFRs 3- to 17-fold; CFRs were higher with comorbidities regardless of dengue severity or age. The odds of in-hospital mortality were significantly higher in those with pulmonary disorders (11.6 [95% CI 7.4–18.2], 12.7 [95% CI 9.3–17.5], and 8.0 [95% CI 4.9–13.1] in Mexico, Brazil, and Colombia, respectively), ischemic heart disease (23.0 [95% CI 6.6–79.6], 5.9 [95% CI 1.4–24.6], and 7.0 [95% CI 1.9–25.5]), and renal disease/failure (8.3 [95% CI 4.8–14.2], 8.0 [95% CI 4.5–14.4], and 9.3 [95% CI 3.1–28.0]) across the three countries; the odds of in-hospital mortality from dengue with comorbidities was at least equivalent or higher than severe dengue alone (4.5 [95% CI 3.4–6.1], 9.6 [95% CI 8.6–10.6], and 9.0 [95% CI 6.8–12.0). In conclusion, the risk of death because of dengue increases with comorbidities independently of age and/or disease severity.

Author Notes

Address correspondence to Alejandro E. Macias, Área De Microbiología, Departamento De Medicina y Nutrición, Universidad de Guanajuato, 20 de Enero 929, Leon, Guanajuato 37000, Mexico. E-mail: aaeemmhh@yahoo.com

Financial support: This work was supported by Sanofi Pasteur, including service provision of database consolidation, data mining, and analysis by Ariana Pharmaceuticals.

Disclaimer: A. E. M. and R. C. have no conflicts of interest to declare. G. L. W. was partially funded by Sanofi Pasteur. C. M., L. C., E. P.-R., N. B., and M.-L. T. are employees of Sanofi Pasteur. D. M., V. R., M. G.-K., and A. E. are employees of Ariana Pharmaceuticals who were contracted to undertake this analysis.

Authors’ addresses: Alejandro E. Macias, Área De Microbiología, Departamento De Medicina y Nutrición, Universidad de Guanajuato, Obregon, León Guanajuato, Mexico, E-mail: aaeemmhh@yahoo.com. Guilherme L. Werneck, Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil, E-mail: gwerneck@iesc.ufrj.br. Raúl Castro, Los Andes University, Bogota, Colombia, E-mail: rcastro@uniandes.edu.co. Cesar Mascareñas, Laurent Coudeville, Nicolas Baurin, and Myew-Ling Toh, Sanofi Pasteur, Lyon, France, E-mails: cesar.mascarenas@sanofi.com, laurent.coudeville@sanofi.com, nicolas.baurin2@sanofi.com, and myew-ling.toh@sanofi.com. David Morley, Vincent Recamier, Mariana Guergova-Kuras, and Adrien Etcheto, Ariana Pharmaceuticals, Paris, France, E-mails: d.morley@arianapharma.com, vincent.recamier@gmail.com, mariana.kuras@free.fr, and a.etcheto@arianapharma.com. Esteban Puentes-Rosas, Sanofi Pasteur, Santa Catarina, Coyoacán, Mexico City, CDMX, Mexico, E-mail: esteban.puentes@sanofi.com.

Joint first authors.

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