Acute Respiratory Failure and Active Bleeding Are the Important Fatality Predictive Factors for Severe Dengue Viral Infection

Abstract

ObjectiveTo determine the outcome of severe dengue viral infection (DVI) and the main dengue fatality risk factors.Study designThe medical records of patients aged <15 years admitted to Songklanagarind Hospital in southern Thailand during 1989–2011 were reviewed. Patients who had dengue hemorrhagic fever (DHF) grades III–IV, organ failure (cardiovascular, respiratory, liver, renal or hematologic), impaired consciousness, or aspartate aminotransferase more than 1,000 units/L, were classified as having severe DVI. To determine the fatality risk factors of severe DVI, the classification trees were constructed based on manual recursive partitioning.ResultsOf the 238 children with severe DVI, 30 (12.6%) died. Compared to the non-fatal DVI cases, the fatal cases had higher rates of DHF grade IV (96.7% vs 24.5%), repeated shock (93.3% vs 27.9%), acute respiratory failure (ARF) (100% vs 6.7%), acute liver failure (ALF) (96.6% vs 6.3%), acute kidney injury (AKI) (79.3% vs 4.5%), and active bleeding requiring blood transfusion (93.3% vs 5.4%), all p<0.01. The combined risk factors of ARF and active bleeding considered together predicted fatal outcome with sensitivity, specificity, and negative and positive predictive values of 0.93 (0.78–0.99), 0.97 (0.93–0.99), 0.99 (0.97–1.00), and 0.82 (0.65–0.93), respectively. The likelihood ratios for a fatal outcome in the patients who had and did not have this risk combination were 32.4 (14.6–71.7) and 0.07 (0.02–0.26), respectively.ConclusionSevere DVI patients who have ARF and active bleeding are at a high risk of death, while patients without these things together should survive.

Diabetes, cardiac disorders and asthma as risk factors for severe organ involvement among adult dengue patients: A matched case-control study

“…On the other hand, as an intrinsic abnormality, impaired TLR3-mediated interferon-β (IFN-β)54 and IFN-λ55 production by asthmatic epithelial cells may also predispose to dengue virus indirectly5657. This allergic inflammatory cascade may also play a role in the development of acute respiratory failure, which was reported to be a risk factor of dengue fatal cases27. Future studies will be required to validate this hypothesis.…”

“…Dengue associated severe organ involvement were cardiovascular18, hepatic141920, renal2122, as well as central nervous systems2324, and to some extent, respiratory252627 and muscular systems2829. Different dengue serotypes may have different severe organ involvements30.…”

A Cohort Study of Adult Patients with Severe Dengue in Taiwanese Intensive Care Units: The Elderly and APTT Prolongation Matter for Prognosis

“…More than 70% of our patients received mechanical ventilation, which had been associated with a poor prognosis in the literature [36, 37]. The respiratory and cardiovascular components of the SOFA score have been reported to be better predictors than other components of the SOFA score in one ROC analysis [23].…”

The outcomes of patients with severe dengue admitted to intensive care units

“…Like another study [ 20 ] which reported that some common etiologies of multiple organ dysfunction—dengue shock syndrome and multiple organ dysfunction syndrome—directly related to the organ failure index present a significant risk of mortality, we found that patients who died had more thoracic (72.2% vs 20.0%), cardiovascular (72.7% vs 17.3%), and multiorgan (93.9% vs 25.5%) failures than did survivors (both P < 0.0001). Other studies have reported that patients who die were more likely to have cardiovascular (100% vs 12%) or respiratory (88% vs 12%) failures than were survivors (both P < 0.01), [ 17 ] that a dengue viral infection with an acute respiratory failure is a significant mortality risk, [ 21 ] and that a lower platelet count before being discharged from the ICU was associated with higher in-hospital mortality. [ 22 ]…”