Risk factors for mortality in patients with dengue: A systematic review and meta-analysis

Abstract

Objective: To investigate risk factors for mortality in dengue. Methods: We performed a systematic review and meta-analysis searching MEDLINE, Embase, SciELO, LILACS Bireme, and OpenGrey databases to identify eligible observational studies of patients with dengue, of both genders, aged 14 years or older, that analysed risk factors associated with mortality and reported adjusted risk measures with their respective confidence intervals (CIs). We estimated the pooled weighted mean difference and 95% CIs with a DerSimonian and Laird random-effects model. We assessed the methodological quality using the Newcastle-Ottawa Scale. Results: Of 1,170 citations reviewed, 18 papers, with a total of 25,851 patients, were included in the systematic review and 12 in the meta-analysis. Severe hepatitis (OR 29.222, 95% CI 3.876–220.314), dengue shock syndrome (OR 23.575, 95% CI 3.664–151.702), altered mental status (OR 3.76, 95% CI 1.67–8.42), diabetes mellitus (OR 3.698, 95% CI 1.196–11.433), and higher pulse rate (OR 1.039, 95% CI 1.011–1.067) are associated with mortality in patients with dengue. All studies included were classified as having a high quality. Conclusions: Proper identification and management of these risk factors should be considered to improve patient outcomes and reduce the hidden burden of this neglected tropical disease. Future well-designed studies are needed to investigate the association of other clinical, radiological, and laboratorial findings with mortality in dengue, as well as to develop prognostic models based on the risk factors found in our study.