Determinants of Mortality from Severe Dengue in Brazil: A Population-Based Case-Control Study

Abstract

Abstract. Although increases in severity of mortality from dengue infection have been observed in Brazil, their determinants are not fully known. A case-control study was conducted by using the National Notifiable Diseases Surveillance System, including patients with severe dengue during 2000-2005. Cases were defined as patients that died and controls were those who survived. Hierarchical multivariate logistic regression was performed. During the study period, there were 12,321 severe cases of dengue and 1,062 deaths. Factors independently associated with death included age 50 years (odds ratio [OR] = 2.29, 95% confidence interval [CI] = 1.59-3.29), 4 years of schooling (OR = 1.83, 95% CI = 1.47-2.28), a rural area (OR =2.84, 95% CI = 2.19-3.69), hospitalization (OR = 1.42, 95% CI = 1.17-1.73), and a high hematocrit (OR = 2.46, 95% CI = 1.85-3.28). Factors associated with a lower chance of dying were female sex (OR = 0.76, 95% CI = 0.67-0.87), history of previous dengue (OR = 0.78, 95% CI = 0.62-0.99), positive tourniquet test result (OR = 0.47, 95% CI = 0.33-0.66), laboratory diagnosis of dengue (OR = 0.75, 95% CI = 0.61-0.92), and a platelet count of 50,000-100,000 cells/mm 3 (OR = 0.56, 95% CI = 0.36-0.87). The risk profile identified in this study should serve to direct public health interventions to minimize deaths.

Characteristics and Risk Factors for Fatality in Patients with Dengue Hemorrhagic Fever, Taiwan, 2014

“…2 A noticeable shift has been observed recently, from epidemics of dengue mainly affecting children to more adult cases being reported, with a particular increase in SD in adults. 1,3,4 However, research concerning adult fatalities as a result of dengue, particularly among the elderly, remains scarce.…”

Postmortem Diagnosis of Dengue as an Epidemiological Surveillance Tool

“…19,20 Moreover, these results suggest that deaths related to dengue may be underreported in regions where there is no verification service or integrated epidemiological surveillance. The rate of clinical suspicion of dengue was low in the cases referred to the CO-RF, although it was during an epidemic.…”

Molecular and clinical epidemiological surveillance of dengue virus in Paraíba, Northeast Brazil

“…However, data on comorbidities are not included in the SINAN, and can only be obtained through investigation of fatal dengue cases [33][34][35][36] .…”