Analysis of signs and symptoms in confirmed cases of severe dengue among children aged 0 to 10 years old.

OBJECTIVE: The prevalent symptoms of severe dengue in pediatric patients are divided into three subgroups: severe plasma leakage, severe bleeding, and severe organ damage. In addition, the seasonal patterns of the disease and the outcomes of cure or death from dengue were evaluated. METHODS: An epidemiological, observational, analytical, cross-sectional study was conducted with data from the Notifiable Disease Information System (SINAN - Sistema de Informação de Agravos de Notificação and DATASUS - Departamento de Informática do Sistema Único de Saúde) of the Ministry of Health from 2019 to 2020. RESULTS: During the study period, 1,857 cases of severe dengue were observed in the pediatric age group, with the most common symptoms being respiratory failure, melena, hematemesis, and altered level of consciousness. The total proportion of patients hospitalized for severe dengue was 89.6%, and 51.2% of these patients died, corroborating the importance of early detection of the disease. CONCLUSION: Severe dengue is more prevalent during the seasonal period, with hot and humid characteristics owing to the mechanism involved in the viral cycle. The most prevalent symptoms of severe dengue in pediatric patients were respiratory failure alone, gastrointestinal bleeding, and altered level of consciousness. It is important to identify signs of severity for early intervention and a better prognosis, considering that death is closely related to a delayed diagnosis.

Prognostic values of serum lactate-to-bicarbonate ratio and lactate for predicting 28-day in-hospital mortality in children with dengue shock syndrome.

This study aimed to assess the clinical utility of blood lactate-to-bicarbonate (L/B) ratio, as a prognostic factor for 28-day in-hospital mortality in children with dengue shock syndrome (DSS), admitted to the pediatric intensive care unit (PICU). This single-center retrospective study was conducted at a tertiary children hospital in southern Vietnam from 2013 to mid-2022. Prognostic models for DSS mortality were developed, using a predefined set of covariates in the first 24 hours of PICU admission. Area under the curves (AUCs), multivariable logistic and Least Absolute Shrinkage and Selection Operator (LASSO) regressions, bootstrapping and calibration slope were performed. A total of 492 children with DSS and complete clinical and biomarker data were included in the analysis, and 26 (5.3%) patients died. The predictive values for DSS mortality, regarding lactate showing AUC 0.876 (95% CI, 0.807-0.944), and that of L/B ratio 0.867 (95% CI, 0.80-0.934) (P values of both biomarkers < .001). The optimal cutoff point of the L/B ratio was 0.25, while that of lactate was 4.2 mmol/L. The multivariable model showed significant clinical predictors of DSS fatality including severe bleeding, cumulative amount of fluid infused and vasoactive-inotropic score (>30) in the first 24 hours of PICU admission. Combined with the identified clinical predictors, the L/B ratio yielded higher prognostic values (odds ratio [OR] = 8.66, 95% confidence interval [CI], 1.96-38.3; P < .01) than the lactate-based model (OR = 1.35, 95% CI, 1.15-1.58; P < .001). Both the L/B and lactate models showed similarly good performances. Considering that the L/B ratio has a better prognostic value than the lactate model, it may be considered a potential prognostic biomarker in clinical use for predicting 28-day mortality in PICU-admitted children with DSS.

Prognostic indicators associated with progresses of severe dengue.

BACKGROUND: Dengue usually progress abnormally, especially in the critical phase. The main causes of death were shock, severe bleeding and organ failure. The aim of our study was to evaluate prognostic indicators of severe dengue according to the phases of the disease progression. METHODS: A cross-sectional study was conducted from July to December 2017 at the National Hospital for Tropical Diseases and the Hospital for Tropical Diseases of Ho Chi Minh City. 326 patients, aged 6 years and over, including 99/326 patients with severe dengue and 227/326 patients with non-severe dengue, hospitalized in the first 3 days of illness, confirmed Dengue virus by the RT-PCR assay have been registered for the study. Clinical manifestations were monitored daily. The hematocrit, white blood cells, platelet, serum albumin, ALT, AST, bilirubin, prothrombin time (PT%, PTs), fibrinogen, aPTT, INR and creatinine were evaluated at two times: febrile phase and critical phase. RESULTS: Independent factors associated with severe dengue were identified on multivariate logistic regression models. During the first 3 days of the disease, the prognostic indicators were platelet count ≤ 100 G/L (OR = 2.2; 95%CI: 1.2-3.9), or serum albumin < 35 g/L (OR = 3.3; 95%CI: 1.8-6.1). From day 4-6, the indicator were AST > 400 U/L (OR = 3.0; 95%CI: 1.1-7.9), ALT > 400 U/L (OR = 6.6; 95%CI: 1.7-24.6), albumin < 35 g/L (OR = 3.0; 95%CI: 1.5-5.9), and bilirubin total >17 µmol/L (OR = 4.6; 95%CI: 2.0-10.4). CONCLUSION: To predict the risk of patients with severe dengue, prognostic laboratory indicators should be indicated consistent with the progression of the disease. During the first 3 days of illness, prognostic indicators should be platelet count, or serum albumin. From the 4th - 6th day of illness, prognostic indicators should be AST, ALT, albumin, or bilirubin total.

Mortality Rates of Severe Dengue Viral Infection Before and After Implementation of a Revised Guideline for Severe Dengue.

OBJECTIVES: To compare the mortality rate of severe dengue (SD) before and after implementation of a revised SD guideline. METHODS: Medical records of SD patients <15 years of age hospitalized during 1998-2020 were reviewed. The revised SD guidelines were implemented in 2016, including intensive monitoring of vital signs and intra-abdominal pressure, the release of intra-abdominal pressure in cases of abdominal compartment syndrome (ACS) and the use of N-acetyl cysteine in cases of acute liver failure. RESULTS: On initial admission, organ failure including severe bleeding, acute respiratory failure, acute kidney injury and acute liver failure was not significantly different between 78 and 23 patients treated in the pre- and postrevised guideline periods, respectively. After hospitalization, the proportions of patients who developed profound shock (68.8% vs. 41.2%), multiorgan failures (60.4% vs. 73.3%), ACS (37.2% vs. 26.1%) and fatal outcome (33.3% vs. 13.0%) were also not significantly different between the pre- and postrevised guideline periods, respectively. In subgroup analysis, the mortality rates in patients with multiorgan failure (44.1% vs. 15.8%), acute respiratory failure and active bleeding (78.1% vs. 37.5%) and ACS (82.8% vs. 33.3%), respectively, were significantly higher in the pre- than the postrevised guideline periods. The durations of time before the liver function tests returned to normal levels, and the mortality rates in acute liver failure patients treated with and without N-acetyl cysteine were not significantly different. CONCLUSIONS: Although following the revised guidelines could not prevent organ failure, the mortality rates in patients with multiorgan failure and/or ACS decreased significantly when following the revised guidelines.

Dengue y sus manifestaciones atípicas en el departamento de Arauca, Colombia 2010-2015. Revisión de la literatura / Dengue and its atypical manifestations in the department of Arauca, Colombia 2010-2015. Literature review

Objetivo: El propósito de este trabajo ha sido describir las manifestaciones clínicas atípicas del dengue que se han reportado desde una mirada global hasta la situación actual de Colombia, principalmente en el Departamento de Arauca. Método: Se realizó una búsqueda de literatura científica en las bases de datos PubMed y Scielo Public Health, se eligieron los descriptores o palabras relacionadas con la enfermedad y se realizó búsqueda para la descripción de reportes de casos de manifestaciones inusuales producidas por la infección por dengue. Finalmente se buscaron reportes de casos en Colombia por la base de datos SciELO Public Health de manifestaciones atípicas producidas por dengue, así como los reportes del Instituto Nacional de Salud de Colombia. Resultados: De la exploración de 80 revisiones, la búsqueda identificó 26 artículos, se revisaron los resúmenes y se seleccionaron 18 por ajustarse al objetivo de la revisión. Se excluyeron 8 ya que no correspondían directamente a un episodio de complicación directa por dengue. Así mismo de las referencias de los casos reportados en la búsqueda inicial, se tomaron en cuenta para enriquecer el contexto de esta revisión. Conclusiones: Las manifestaciones atípicas resultados de la infección por el virus del dengue, cada vez son más frecuentemente en todo el mundo. Es notorio en esta revisión que la población infantil es blanco de esta infección viral y que la prevención debe estar enfocada a disminuir la transmisión vectorial con el fin de proteger la población en riesgo, además cabe resaltar que las manifestaciones clínicas más prevalentes encontradas fueron las neurológicas y gastrointestinales afectando a la población infantil en su mayoría.(AU)

Objective: The purpose of this work has been to describe the atypical clinical manifestations of dengue that have been reported from a global perspective to the current situation in Colombia, mainly in the Department of Arauca. Method: A scientific literature search was carried out in the PubMed and Scielo Public Health databases, the descriptors or words related to the disease were chosen and a search was carried out for the description of case reports of unusual manifestations produced by dengue infection. Finally, reports of cases in Colombia were searched through the Scielo Public Health database of atypical manifestations produced by dengue, as well as reports from the National Institute of Health of Colombia. Results: From the exploration of 80 reviews, the search identified 26 articles, the abstracts were reviewed, and 18 were selected to fit the purpose of the review. 8 of them were excluded because, they did not correspond directly to an episode of complication from dengue. Likewise, the references of the cases reported in the initial search were taken into account to enrich the context of this review. Conclusions: Atypical manifestations resulting from dengue virus infection are becoming more and more frequent throughout the world. It is well known in this review that the child population is the target of this viral infection and that prevention should be focused on reducing vector transmission in order to protect the population at risk, it should also be noted that the most prevalent clinical manifestations found were neurological and gastrointestinal, affecting the majority of the child population.(AU)

Predictive markers for the early prognosis of dengue severity: A systematic review and meta-analysis.

BACKGROUND: Predictive markers represent a solution for the proactive management of severe dengue. Despite the low mortality rate resulting from severe cases, dengue requires constant examination and round-the-clock nursing care due to the unpredictable progression of complications, posing a burden on clinical triage and material resources. Accordingly, identifying markers that allow for predicting disease prognosis from the initial diagnosis is needed. Given the improved pathogenesis understanding, myriad candidates have been proposed to be associated with severe dengue progression. Thus, we aim to review the relationship between the available biomarkers and severe dengue. METHODOLOGY: We performed a systematic review and meta-analysis to compare the differences in host data collected within 72 hours of fever onset amongst the different disease severity levels. We searched nine bibliographic databases without restrictive criteria of language and publication date. We assessed risk of bias and graded robustness of evidence using NHLBI quality assessments and GRADE, respectively. This study protocol is registered in PROSPERO (CRD42018104495). PRINCIPAL FINDINGS: Of 4000 records found, 40 studies for qualitative synthesis, 19 for meta-analysis. We identified 108 host and viral markers collected within 72 hours of fever onset from 6160 laboratory-confirmed dengue cases, including hematopoietic parameters, biochemical substances, clinical symptoms, immune mediators, viral particles, and host genes. Overall, inconsistent case classifications explained substantial heterogeneity, and meta-analyses lacked statistical power. Still, moderate-certainty evidence indicated significantly lower platelet counts (SMD -0.65, 95% CI -0.97 to -0.32) and higher AST levels (SMD 0.87, 95% CI 0.36 to 1.38) in severe cases when compared to non-severe dengue during this time window. CONCLUSION: The findings suggest that alterations of platelet count and AST level-in the first 72 hours of fever onset-are independent markers predicting the development of severe dengue.

Early Predictors of Mortality in Children with Severe Dengue Fever: A Prospective Study.

OBJECTIVE: The aim of the study was to identify early predictors of mortality in children with severe dengue fever admitted to pediatric intensive care unit (PICU). MATERIALS AND METHODS: All consecutive children with laboratory-confirmed severe dengue fever were enrolled in this prospective observational study. Besides demographic data, disease severity and organ dysfunction scores, laboratory investigations and interventions are done in PICU were recorded and analyzed. RESULTS: During the study period of 42 months, 172 patients with dengue fever were admitted to PICU. A total of 78 (45.3%) patients with severe dengue fever were included and analyzed. There were 20 (25.6%) deaths. There were significant differences in disease severity and organ dysfunction scores, transaminases, blood lactate level and serum creatinine between survivors and nonsurvivors. A significantly higher number of nonsurvivors required interventions in first 24 hours of admission. Platelet counts (P value 0.22) and hematocrit (P value 0.47) were not statistically different in 2 groups. There was a significantly high vasopressor-inotrope score (VIS) (<0.001) and positive fluid balance >10% (0.002) in nonsurvivors. Multivariate stepwise logistic regression analysis identified serum glutamic pyruvic transaminases (≥ 284 IU/L; odds ratio [OR] 1.002, 95% confidence interval [CI]: 1.001-1.003), blood lactate level (≥2.73 mmol/L; OR 2.08, 95% CI: 1.354-3.202), Pediatric Risk of Mortality score at 12 hours (≥14.5; OR 1.35, 95% CI: 1.077-1.693), VIS (≥22.5, OR 1.129, 95% CI: 1.059-1.204) and positive fluid balance >10% (OR 22.937, 95% CI: 2.393-219.84) at 24 hours of admission as independent predictors of mortality. CONCLUSION: Disease severity, hyperlactatemia at admission, need for multiple vasoactive drugs and positive fluid balance are predictors of mortality in severe dengue infection in children admitted to PICU.

Unusual, neurological and severe dengue manifestations during the outbreak in Sri Lanka, 2017.

BACKGROUND: Sri Lanka experienced its largest dengue outbreak in 2017 with more than 185,000 dengue cases including at least 250 fatalities. OBJECTIVES: Our study aimed to characterize the clinical, immunological and virological features of confirmed dengue patients in Sri Lanka during the outbreak in 2017 when unusual manifestations of severe dengue were observed. STUDY DESIGN: Sera from 295 patients who were admitted to Teaching Hospital Kandy, Kandy, Sri Lanka between March 2017- January 2018 were subjected to NS1 antigen, IgM and IgG ELISAs, virus isolation, conventional and real time RT-PCR and next generation sequencing. RESULTS: Primary and secondary infections were detected in 48.5 % and 51.5 % of the study population, respectively. Two hundred twenty five DENV strains were isolated (219 DENV-2, one DENV-3, two DENV-4, two mixed infections of DENV-2 and -3 and one mixed infection of DENV-2 and -4). Unusual and severe manifestations such as encephalitis, encephalopathy, liver failure, kidney failure, myocarditis, Guillain-Barré syndrome and multi-organ failure were noted in 44 dengue patients with 11 deaths. The viraemia levels in patients with primary infection and unusual manifestations were significantly higher compared to those in patients with secondary infection. A new clade of DENV-2 Cosmopolitan genotype strains was observed with the strains closely related to those from China, Malaysia, Indonesia, Singapore and Taiwan. CONCLUSIONS: The new clade of DENV-2 cosmopolitan genotype observed in Sri Lanka in 2017 caused an unprecedented, severe dengue outbreak. The emergence of DENV-3 and DENV-4 in the 2017 outbreak might cause future outbreaks in Sri Lanka.

Severe dengue and liver involvement: an overview and review of the literature.

Introduction: Two billion population are at risk of dengue fever and by 2080, over six billion population will be at risk. Hepatitis is common in dengue and the liver is invariably involved in severe cases. We conducted a literature review using the PubMed database on articles covering a broad range of issues related to dengue and hepatitis.Areas covered: This article overviews available literature on changes in the definition of severe dengue, pathogenesis of liver involvement in dengue, clinical manifestations, and predictors of mortality in severe dengue with liver involvement, impact of viral hepatitis co-infections and hepatotoxic drugs, and hemophagocytic lymphohistiocytosis.Expert commentary: Hepatitis is commonly seen in dengue however the degree of elevation of transaminases did not correlate well with severity of illness in observational studies, except in the elderly. The underlying pathogenesis of liver injury is still being elucidated and further studies are required to fully understand the cellular pathways. Acute or chronic viral hepatitis does not appear to affect dengue outcomes. Commonly used medications such as paracetamol and statins may influence dengue outcomes.

Clinical Indicators of Fatal Dengue in Two Endemic Areas of Colombia: A Hospital-Based Case-Control Study.

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.

Validation of Decision Groups in Patients with Dengue Fever: A Study during 2015 Outbreak in Taiwan.

The management of dengue fever (DF) has been suggested to be categorized into decision groups A, B, and C; however, its usefulness in predicting mortality is still unclear, and hence we conducted this study to clarify this issue. We conducted a study by recruiting 2,358 patients with DF from the 2015 outbreak in the Chi-Mei Medical Center. Demographic data, vital signs, clinical symptoms and signs, coexisting morbidities, laboratory data, decision groups categorized according to World Health Organization for clinical management of dengue in 2012, and 30-day mortality rates were included for analysis. The overall 30-day mortality rate was 1.4%. The 30-day mortality rates in decision groups A, B, and C were 0%, 0.5%, and 46.2%, respectively. Compared with Group A, there was a higher mortality risk in Group C (odds ratio [OR]: 1,480, 95% confidence interval [CI]: 195-11,200). The area under the curve of the variable of Group C was excellent (OR: 0.92, 95% CI: 0.85-0.99). The sensitivity, specificity, positive predictive value, and negative predictive value for predicting 30-day mortality in Group C were 88.2%, 98.5%, 46.2%, and 99.8%, respectively. This study showed that decision Group C has a good predictive value for 30-day mortality. Further studies including validation in other nations are warranted.

Comorbidities increase in-hospital mortality in dengue patients in Brazil.

Dengue remains an unmet public health burden. We determined risk factors for dengue in-hospital mortality in Brazil. Of 326,380 hospitalised dengue cases in 9-45-year-old individuals, there were 971 deaths. Risk of dying was 11-times higher in the presence of underlying common comorbidities (renal, infectious, pulmonary disease and diabetes), similar to the risk of dying from severe dengue and much higher with the combination. Ensuring access to integrated dengue preventative measures in individuals aged ≥ 9 years including those with comorbidities may help achieve the WHO objective of 50% reduction in mortality and 25% reduction in morbidity due to dengue by 2020.

Postmortem Findings in Fatal Dengue Haemorrhagic Fever.

During recent epidemic of dengue fever in Peshawar, there has been a significant increase in dengue-associated admission in hospitals. We performed a postmortem examination of dengue-related death in our hospital. He was a young man, who was given supportive care at our tertiary care hospital, despite that he died on seventh day of admission. The autopsy findings in this case included multiple organ involvement including heart, lungs, kidneys and brain. There was histopathological finding of microabscesses in heart, lungs, brain and kidneys, which have not been reported in the literature yet. In patients with severe dengue, deaths do occur despite current supportive management. Knowing the pathological processes involved in severe disease, it can help identify early predictors of disease severity and help applying adequate clinical interventions.

Prediction of mortality in severe dengue cases.

BACKGROUND: Increasing incidence of dengue cases in Malaysia over the last few years has been paralleled by increased deaths. Mortality prediction models will therefore be useful in clinical management. The aim of this study is to identify factors at diagnosis of severe dengue that predicts mortality and assess predictive models based on these identified factors. METHOD: This is a retrospective cohort study of confirmed severe dengue patients that were admitted in 2014 to Hospital Kuala Lumpur. Data on baseline characteristics, clinical parameters, and laboratory findings at diagnosis of severe dengue were collected. The outcome of interest is death among patients diagnosed with severe dengue. RESULTS: There were 199 patients with severe dengue included in the study. Multivariate analysis found lethargy, OR 3.84 (95% CI 1.23-12.03); bleeding, OR 8.88 (95% CI 2.91-27.15); pulse rate, OR 1.04 (95% CI 1.01-1.07); serum bicarbonate, OR 0.79 (95% CI 0.70-0.89) and serum lactate OR 1.27 (95% CI 1.09-1.47), to be statistically significant predictors of death. The regression equation to our model with the highest AUROC, 83.5 (95% CI 72.4-94.6), is: Log odds of death amongst severe dengue cases = - 1.021 - 0.220(Serum bicarbonate) + 0.001(ALT) + 0.067(Age) - 0.190(Gender). CONCLUSION: This study showed that a large proportion of severe dengue occurred early, whilst patients were still febrile. The best prediction model to predict death at recognition of severe dengue is a model that incorporates serum bicarbonate and ALT levels.

Comorbidities increase in-hospital mortality in dengue patients in Brazil

Dengue remains an unmet public health burden. We determined risk factors for dengue in-hospital mortality in Brazil. Of 326,380 hospitalised dengue cases in 9-45-year-old individuals, there were 971 deaths. Risk of dying was 11-times higher in the presence of underlying common comorbidities (renal, infectious, pulmonary disease and diabetes), similar to the risk of dying from severe dengue and much higher with the combination. Ensuring access to integrated dengue preventative measures in individuals aged ≥ 9 years including those with comorbidities may help achieve the WHO objective of 50% reduction in mortality and 25% reduction in morbidity due to dengue by 2020.

Predicción de mortalidad en pacientes con dengue grave en Unidad de Cuidados Intensivos / Prediction of mortality in severe dengue in the Intensive Care Unit

Introducción: el dengue constituye un importante problema de salud pública para las regiones endémicas. Objetivo: identificar variables clínicas, biológicas e imaginológicas asociadas a la probabilidad de morir en pacientes con dengue grave ingresados en la unidad de cuidados intensivos del Hospital General Docente Dr Agostinho Neto entre enero y noviembre de 2014. Método: se realizó un estudio epidemiológico, caso-control, retrospectivo en el que se incluyen todos los pacientes ingresados en el escenario investigacional con diagnóstico de dengue grave y que fueron confirmados serológicamente, en dicho período de estudio. Se emplearon estadígrafos descriptivos y análisis univariado, bivariado y de regresión logística para determinar la asociación de las variables seleccionadas con la mortalidad. Se analizaron 90 casos, 10 fallecidos y 80 egresados vivos. Resultados: En el análisis univariado resultaron tener diferencias significativas la presión arterial media, el gasto urinario y el conteo plaquetario, la glicemia, la acidosis metabólica y el derrame pericárdico. En el análisis multivariado, mostraron asociación con la mortalidad el gasto urinario y la presión arterial media, la glicemia, la acidosis metabólica y el derrame pericárdico. El derrame pericárdico y la acidosis metabólica tienen aceptables medidas de validez y seguridad diagnósticas de la probabilidad de morir. Conclusiones: La presión arterial media y el gasto urinario 3, la glicemia 2 y 3, ¿la acidosis metabólica con DB? -8 mmol/l en el momento 1 y 2, y el derrame pericárdico en el momento 3 resultaron ser variables con capacidad predictiva de mortalidad en pacientes con dengue grave(AU)

Introduction: dengue is an important public health problem for endemic regions. Objective: to identify clinical, biological and imaging variables associated with the probability of dying in patients with severe dengue admitted to the intensive care unit of the General Teaching Hospital Dr. Agostinho Neto between January and November 2014. Method: a study was conducted epidemiological, case-control, retrospective study in which all patients were admitted to the research scenario with a diagnosis of severe dengue and whom were confirmed serologically in this studied period. Descriptive statistics and univariate, bivariate and logistic regression were used to determine the association of the selected variables with mortality. It were analyzed 90 cases, 10 deaths and 80 alive. Results: In the univariate analysis, mean blood pressure, urinary output and platelet count, glycaemia, metabolic acidosis and pericardial effusion were found to have significant differences. In the multivariate analysis, that shown an association with mortality, urinary output and mean arterial pressure, glycemia, metabolic acidosis and pericardial effusion. Pericardial effusion and metabolic acidosis have acceptable measures of diagnostic validity and safety of the probability of dying. Conclusions: Mean arterial pressure and urinary output 3, glycemia 2 and 3, metabolic acidosis with DB?8 mmol / l at time 1 and 2 and pericardial effusion at time 3 were found to be variables with predictive capacity of mortality in patients with severe dengue(AU)

Predicción de mortalidad en pacientes con dengue grave en Unidad de Cuidados Intensivos / Prediction of mortality in severe dengue in the Intensive Care Unit

Introducción: el dengue constituye un importante problema de salud pública para las regiones endémicas. Objetivo: identificar variables clínicas, biológicas e imaginológicas asociadas a la probabilidad de morir en pacientes con dengue grave ingresados en la unidad de cuidados intensivos del Hospital General Docente "Dr. Agostinho Neto" entre enero y noviembre de 2014. Método: se realizó un estudio epidemiológico, caso-control, retrospectivo en el que se incluyen todos los pacientes ingresados en el escenario investigacional con diagnóstico de dengue grave y que fueron confirmados serológicamente, en dicho período de estudio. Se emplearon estadígrafos descriptivos y análisis univariado, bivariado y de regresión logística para determinar la asociación de las variables seleccionadas con la mortalidad. Se analizaron 90 casos, 10 fallecidos y 80 egresados vivos. Resultados: En el análisis univariado resultaron tener diferencias significativas la presión arterial media, el gasto urinario y el conteo plaquetario, la glicemia, la acidosis metabólica y el derrame pericárdico. En el análisis multivariado, mostraron asociación con la mortalidad el gasto urinario y la presión arterial media, la glicemia, la acidosis metabólica y el derrame pericárdico. El derrame pericárdico y la acidosis metabólica tienen aceptables medidas de validez y seguridad diagnósticas de la probabilidad de morir. Conclusiones: La presión arterial media y el gasto urinario 3, la glicemia 2 y 3, la acidosis metabólica con DB? -8 mmol/l en el momento 1 y 2, y el derrame pericárdico en el momento 3 resultaron ser variables con capacidad predictiva de mortalidad en pacientes con dengue grave(AU)

Introduction: dengue is an important public health problem for endemic regions. Objective: to identify clinical, biological and imaging variables associated with the probability of dying in patients with severe dengue admitted to the intensive care unit of the General Teaching Hospital "Dr. Agostinho Neto" between January and November 2014. Method: a study was conducted epidemiological, case-control, retrospective study in which all patients were admitted to the research scenario with a diagnosis of severe dengue and whom were confirmed serologically in this studied period. Descriptive statistics and univariate, bivariate and logistic regression were used to determine the association of the selected variables with mortality. It were analyzed 90 cases, 10 deaths and 80 alive. Results: In the univariate analysis, mean blood pressure, urinary output and platelet count, glycaemia, metabolic acidosis and pericardial effusion were found to have significant differences. In the multivariate analysis, that shown an association with mortality, urinary output and mean arterial pressure, glycemia, metabolic acidosis and pericardial effusion. Pericardial effusion and metabolic acidosis have acceptable measures of diagnostic validity and safety of the probability of dying. Conclusions: Mean arterial pressure and urinary output 3, glycemia 2 and 3, metabolic acidosis with DB?8 mmol / l at time 1 and 2 and pericardial effusion at time 3 were found to be variables with predictive capacity of mortality in patients with severe dengue(AU)

Symptoms associated with adverse dengue fever prognoses at the time of reporting in the 2015 dengue outbreak in Taiwan.

BACKGROUND: Tainan experienced the most severe dengue epidemic in Taiwan in 2015. This study investigates the association between the signs and symptoms at the time of reporting with the adverse dengue prognoses. METHODS: A descriptive study was conducted using secondary data from the Dengue Disease Reporting System in Tainan, Taiwan, between January 1 and December 31, 2015. A multivariate stepwise logistic regression was used to identify the risk factors for the adverse prognoses: ICU admissions and mortality. RESULTS: There were 22,777 laboratory-confirmed reported cases (mean age 45.6 ± 21.2 years), of which 3.7% were admitted to intensive care units (ICU), and 0.8% were fatal. The most common symptoms were fever (92.8%), myalgia (26.6%), and headache (22.4%). The prevalence of respiratory distress, altered consciousness, shock, bleeding, and thrombocytopenia increased with age. The multivariate analysis indicated that being in 65-89 years old age group [Adjusted Odds Ratio (aOR):4.95], or the 90 years old and above age group (aOR: 9.06), and presenting with shock (aOR: 8.90) and respiratory distress (aOR: 5.31) were significantly associated with the risk of ICU admission. While old age (aOR: 1.11), respiratory distress (aOR: 9.66), altered consciousness (aOR: 7.06), and thrombocytopenia (aOR: 2.55) were significantly associated with the risk of mortality. CONCLUSIONS: Dengue patients older than 65 and those with severe and non-specific signs and symptoms at the time of reporting were at a higher risk of ICU admission and mortality. First-line healthcare providers need to be aware of the varied presentations between the different age groups to allow early diagnosis and in-time management, which would prevent ICU admissions and fatalities in dengue patients.