Prognostic factors in severe dengue patients: A multi-center retrospective cohort study

Abstract

Background/purpose Early detection of severe dengue (SD) and appropriate management are crucial in reducing the case fatality rate. The objective of this study was to investigate the clinical characteristics of SD and identify independent risk factors associated with mortality among SD patients. Methods A retrospective study was conducted at two medical center hospitals between 2002 and 2019, involving patients aged ≧18 years with laboratory-confirmed SD. Results This study included 294 patients with SD, of whom 203 (69%) survived and 91 (31%) died. Among the 294 SD patients, 103 (35%) experienced acute kidney injury, 54 (18.4%) had pneumonia, and 19 (6.5%) had bacteremia. Among the 286 patients with available alanine aminotransferase (ALT) data, 41 (14.3%) experienced severe hepatitis (ALT>1000U/L). The median time from illness onset to death among the 91 SD patients who died was 5 days. Multivariable regression analysis revealed increasing odds of death associated with older age (odds ratio [OR], 1.037; 95% confidence interval [CI], 1.009–1.066), altered consciousness (OR, 8.591; 95% CI, 2.914–25.330), gastrointestinal bleeding (OR, 1.939; 95% CI, 1.037–3.626), and leukocytosis (OR, 2.504; 95% CI, 1.124–5.578) upon arrival, as well as organ impairment during hospitalization, including acute kidney injury (OR, 2.627; 95% CI, 1.373–5.028), severe hepatitis (OR, 5.324; 95% CI, 2.199–12.889), and pneumonia (OR, 2.250; 95% CI, 1.054–4.802). Conclusions Our findings underscore the importance of early recognition and intervention by frontline physicians in identifying SD patients at high risk of mortality. This information can significantly contribute to reducing fatalities and improving the overall management of SD cases.