Clinical profile and factors associated with hospitalization during a Chikungunya epidemic in Ceará, Brazil

Abstract

Introduction: The aim of this study was to characterize the clinical-epidemiological profile of Chikungunya virus infection and the factors associated with hospitalization during the peak of the most recent epidemic period in Brazil (2016-2017). Methods: Two official databases of the State Health Secretariat of Ceará were used, and a total of 182,731 notifications were analyzed. Results: Independent factors associated with hospital admission were chronic kidney disease (OR 4.56, 95% CI 3.36-6.17), hypertension (OR 1.90, 95% CI 1.69-2.14), leukopenia (OR 1.89, 95% CI 1.56-2.30) and diabetes mellitus (OR 1.70, 95% CI 1.44-1.99). Conclusions: The pre-existing comorbidities have shown the potential to destabilize the patients' clinical status.

Events preceding death among chikungunya virus infected patients: a systematic review.

“…The CHIK-F intra-hospital lethality varies considerably, ranging from 4% to 29% 17,19,26,57,71 . Also, there is evidence pointing that the lethality in critically ill CHIK-F group of patients is higher than that in all critically ill patients in the intensive care units (ICU) 24,50 , although this may be controversial when adjusting lethality for severity scores 24,36 .…”

“…Nevertheless, there is a mix of data pointing to similar clinical features of disease severity observed in this review leading to hospitalization of CHIK-F cases. There is evidence pointing to a higher rate of hospitalization of CHIK-F patients when compared with the general population, and this is more evident in the extreme age groups 47,57,75 , and with diabetes or hypertension 36,57 . Additionally, there is a clear trend of disease severity proportion being higher in older patients 17,38,53 .…”

“…Additionally, there is a clear trend of disease severity proportion being higher in older patients 17,38,53 . Also, there is evidence that subjects with a typical presentation are less likely to be hospitalized, and subjects with signs of bleeding, vomiting, leukopenia, severe arthralgia, with neurological findings, or in the extreme age groups are more likely to be hospitalized 57,75,76 . Although comorbidities and unusual CHIK-F presentation are more frequent as age increases, there seems to be a small effect of age on hospitalization even when adjusted for comorbidities 76 .…”

Chikungunya Death Risk Factors in Brazil, in 2017: A case-control study

“…This symptom has been reported as being more frequent among people who died in other cities around the world [ 16 ]. In addition, having a record of high fever has also been associated with patients with severe chikungunya who required hospitalization [ 9 , 17 , 18 ]. This symptom is likely to be very intense due to the increase in pro-inflammatory cytokines such as IL-6 or IFN-α which are stimulated as a result of viral infection.…”

“…It is important to highlight that patients with thrombocytopenia are often patients with worse prognosis both in the pediatric population and in adults [ 16 , 39 , 40 ]. Leukopenia has also been associated with greater severity and need for hospitalization [ 18 ]. Changes in liver enzymes, increased urea creatinine and elevated CRP were also good predictors of death and should be considered in the presence of a patient with clinical suspicion of chikungunya.…”