Determinants of mortality and prolonged hospital stay among dengue patients attending tertiary care hospital: a cross-sectional retrospective analysis

Abstract

ObjectivesDengue imposes substantial economic, societal and personal burden in terms of hospital stay, morbidity and mortality. Early identification of dengue cases with high propensity of increased hospital stay and death could be of value in isolating patients in need of early interventions. The current study was aimed to determine the significant factors associated with dengue-related prolonged hospitalisation and death.DesignCross-sectional retrospective study.SettingTertiary care teaching hospital.ParticipantsPatients with confirmed dengue diagnosis were stratified into two categories on the basis of prolonged hospitalisation (≤3 days and >3 days) and mortality (fatal cases and non-fatal cases). Clinico-laboratory characteristics between these categories were compared by using appropriate statistical methods.ResultsOf 667 patients enrolled, 328 (49.2%) had prolonged hospitalisation. The mean hospital stay was 4.88±2.74 days. Multivariate analysis showed that dengue haemorrhagic fever (OR 2.3), elevated alkaline phosphatase (ALP) (OR 2.3), prolonged prothrombin time (PT) (OR 1.7), activated partial thromboplastin time (aPTT) (OR 1.9) and multiple-organ dysfunctions (OR 2.1) were independently associated with prolonged hospitalisation. Overall case fatality rate was 1.1%. Factors associated with dengue mortality were age >40 years (p=0.004), secondary infection (p=0.040), comorbidities (p<0.05), acute kidney injury (p<0.001), prolonged PT (p=0.022), multiple-organ dysfunctions (p<0.001), haematocrit >20% (p=0.001), rhabdomyolosis (p<0.001) and respiratory failure (p=0.007). Approximately half of the fatal cases in our study had prolonged hospital stay of greater than three days.ConclusionsThe results underscore the high proportion of dengue patients with prolonged hospital stay. Early identification of factors relating to prolonged hospitalisation and death will have obvious advantages in terms of appropriate decisions about treatment and management in high dependency units.

Predictors of mortality in adult patients with dengue: a study from South India

“…There is evidence from available literature showing an association between mortality and various clinical, biochemical and haematological parameters like haematocrit, prothrombin time, activated partial thromboplastin time, lactate levels, acute kidney injury and ARDS. [6][7][8][9] In our study, there was no relation of mortality with gender of the patients. Males constituted 64% of the 14 deaths (p value = 0.534).…”

“…6 Pinto RC from Brazil reported 62 deaths (0.06%) among 105,459 cases diagnosed with dengue between 2001 and 2013, however the mortality among severe dengue cases was 3.8% (61 out of 1605). 5 A recent report from Kerala state of South India reported 1.76% mortality among 1308 cases of dengue.…”

“…Case fatality rate due to dengue reported from most countries is less than 5% but in absence of early recognition and proper management it may go high. [5][6][7][8][9] Early identification of the risk factors associated with mortality, would help clinicians prioritise the management of high-risk patients to reduce morbidity and mortality.…”

Clinical and epidemiological characteristics of imported dengue fever among inbound passengers: Infrared thermometer–based active surveillance at an international airport

“…Compared with those of a younger age, older persons could be more likely to develop clinical dengue with typical symptoms/signs that can be detected by this surveillance system. Furthermore, the severity of the disease also increases with the age of the patient [31], and older age has been found to be an important determinant of mortality in several studies [32,33]. Early recognition of dengue in senior passengers can potentially improve the outcome of infection through appropriate supportive treatment.…”

Factors Associated with Dengue Virus Infection and Reinfection in Asymptomatic Children in Two Colombian Municipalities

“…Avoiding proper treatment of cases and not recognizing severe cases early are some of the most important factors that affect the increase in the number of cases of severe dengue and fatal cases. [44][45][46] As a result of the large panel of diagnostic tests used, we have been able to report a high proportion of children with asymptomatic infections (40.1%). This is of particular importance because the Colombian surveillance system has reported in recent years that children younger than 14 years is the group with the highest number of cases of dengue, severe dengue, and dengue lethality, 12,15,[47][48][49] and that the subgroup aged 5-9 years are the most affected, similar to what was found in this study.…”