Early Predictors of Mortality in Children with Severe Dengue Fever: A Prospective Study

Sachdev, Anil; Pathak, Divyank; Gupta, Neeraj; Simalti, Ashish Kumar; Gupta, Dhiren; Gupta, Suresh; Chugh, Parul

doi:10.1097/inf.0000000000003179

Cited by 11 publications

(18 citation statements)

References 39 publications

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“…Disease severity at admission, need for multiple vasoactive drugs and mechanical ventilation are predictor of mortality in sever dengue infection in children admitted in PICU. 15 In our study most common cause of death was encephalitis followed by DIC. One of the limitation of this study is, in view of small sample size due to limited data collection at a single centre only second , clinical classification of dengue was used for stratification of severity which might cause misclassification bias due to subjective nature of the assessment.…”

Section: Resultssupporting

confidence: 46%

Pattern of clinical presentation, lab findings and mortality risk among patients of dengue fever admitted in pediatric intensive care unit in a tertiary care centre in South-east Rajasthan

Kumari¹,

Yadav²,

Pareet³

et al. 2022

ijhs

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Background: India is one of the 7 identified countries in south-east Asia region regularly reporting dengue fever outbreaks. Dengue can present with varying degrees of severity of illness in Indian children, present study is aimed at studying the clinical presentation lab findings and mortality risk among patients of dengue fever admitted in PICU in a tertiary care centre in South-east Rajasthan. Methods: It is a retrospective observational study. All dengue seropositive patients admitted in PICU from August 2021 to October 2021 were included in the study. Patients were classified based on National Vector Borne Disease Control Program (NVBDCP). Clinical presentation laboratory findings and mortality risk among patient were studied. esults: Out of 61 patients with dengue, 28(46%) were males and 33(54%) were females. Fever was present in 100% cases followed by GI symptoms vomiting(54.1%), pain abdomen(52.5%) and bleeding manifestations(26.2%) were common presenting complaints. On examination common findings were conjunctival congestion (57%) , hepatomegaly (44%) and flushing (26%). Among complications hypotension/shock (51%) was the commonest followed by hemorrhage (31%), pleural effusion and hepatitis each 21%. Most common bleeding manifestation was melena (19%). Most common affected age group was between10-15 years (42.6%).

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Section: Resultssupporting

confidence: 46%

Pattern of clinical presentation, lab findings and mortality risk among patients of dengue fever admitted in pediatric intensive care unit in a tertiary care centre in South-east Rajasthan

Kumari¹,

Yadav²,

Pareet³

et al. 2022

ijhs

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“…A case–control study [26] done in Brazil comparing children under 13 years with severe dengue who died with children with severe dengue who survived showed that no significant association was observed between any laboratory findings and death and the factor most strongly associated with death was severe bleeding (hemoptysis). In a recent cohort study [27 ▪▪ ] in India, during the study period of 42 months, 172 children with dengue were admitted to a pediatric ICU; a total of 78 (45.3%) patients developed severe dengue fever and 20 died. Independent predictors of mortality included higher levels of transaminases, blood lactate and positive fluid balance greater than 10% at 24 h of admission.…”

Section: Clinical Coursementioning

confidence: 99%

Changing epidemiology of dengue fever in children in South America

Fonseca

2023

Current Opinion in Pediatrics

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Purpose of reviewDengue is the most important arthropod-borne viral disease of public health significance. Its geographic distribution includes 128 countries worldwide, affecting 390 million people every year causing significant morbidity and mortality in children and adults everywhere.Recent findingsIn the past, severe dengue affected mostly adults in the Americas; this scenario has changed and now cases of dengue, severe dengue, and dengue deaths have increased in children under 15 years in Brazil and in Colombia. Dengue and COVID-19 co-infections have been reported in South America, with increased hospitalization. A dengue vaccine for 9-year-old children and older children and adults who have serological evidence of previous dengue has been licensed in many countries; a different dengue vaccine trial for 4–16-year-old children has demonstrated decrease in clinical dengue and decrease in dengue hospitalizations.SummaryThere is no specific treatment of dengue, and a changing climate, insecticide resistance and urban expansion have permitted the vector's spread, making the vector control almost impossible. The hope for dengue control relies on vaccine development; there is important research on this area with one vaccine already licensed and another one showing promising results.

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“…The in-hospital mortality rate of pediatric dengue-infected patients was reported approximately 25%. [6] Nonetheless, dengue fatality can be dramatically reduced to <1% with appropriate and timely treatments by intervening predictors of dengue severity identified on PICU admission. [5,27] Predictors of dengue-related death include significantly elevated transaminases, high blood lactate levels, positive fluid balance, DSS, and systolic shock index > 1, requiring multiple vasoactive drugs.…”

Section: Discussionmentioning

confidence: 99%

“…[4] Dengue shock syndrome accounts for poor outcomes in hospitalized children. [5,6] In the absence of timely management, the in-hospital mortality rate of dengue-infected patients ranges from 20% to 25.6%. [5,6] Dengue continues to be a major global public health concern, requiring substantial joint efforts to reduce morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Associations of obesity and dengue-associated mortality, acute liver failure and mechanical ventilation in children with dengue shock syndrome

Nguyen,

et al. 2023

Medicine

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Dengue-associated complications, including dengue shock syndrome, severe respiratory distress, and pediatric acute liver failure (PALF), are associated with high mortality rates in patients with dengue. There is increasing prevalence of overweight and obesity among children worldwide. Obesity may activate inflammatory mediators, leading to increased capillary permeability and plasma leakage in patients with dengue. Several studies have shown a correlation between obesity and DSS, but did not include dengue fatality or PALF. Therefore, we hypothesized possible associations between obesity and critical dengue-associated clinical outcomes among PICU-admitted children with DSS, including dengue-related mortality, mechanical ventilation (MV) requirements, and dengue-associated PALF. The nutritional status of the participants was assessed using World Health Organization growth charts. A total of 858 participants with complete nutritional data were enrolled in this study. Obesity was significantly associated with risk of severe respiratory failure and MV support (odds ratio = 2.3, 95% CI: 1.31–4.06, P < .01); however, it was not associated with dengue-associated mortality or acute liver failure. Obese pediatric patients with DSS should be closely monitored for severe respiratory distress and the need for high-flow oxygenation support, particularly MV, soon after hospitalization.

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Early Predictors of Mortality in Children with Severe Dengue Fever: A Prospective Study

Abstract: Supplemental Digital Content is available in the text.

Cited by 11 publications

References 39 publications

Pattern of clinical presentation, lab findings and mortality risk among patients of dengue fever admitted in pediatric intensive care unit in a tertiary care centre in South-east Rajasthan

Pattern of clinical presentation, lab findings and mortality risk among patients of dengue fever admitted in pediatric intensive care unit in a tertiary care centre in South-east Rajasthan

Changing epidemiology of dengue fever in children in South America

Associations of obesity and dengue-associated mortality, acute liver failure and mechanical ventilation in children with dengue shock syndrome

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