Mortality Rates of Severe Dengue Viral Infection Before and After Implementation of a Revised Guideline for Severe Dengue

Abstract

Objectives: To compare the mortality rate of severe dengue (SD) before and after implementation of a revised SD guideline. Methods: Medical records of SD patients <15 years of age hospitalized during 1998-2020 were reviewed. The revised SD guidelines were implemented in 2016, including intensive monitoring of vital signs and intraabdominal pressure, the release of intra-abdominal pressure in cases of abdominal compartment syndrome (ACS) and the use of N-acetyl cysteine in cases of acute liver failure. Results: On initial admission, organ failure including severe bleeding, acute respiratory failure, acute kidney injury and acute liver failure was not significantly different between 78 and 23 patients treated in the preand postrevised guideline periods, respectively. After hospitalization, the proportions of patients who developed profound shock (68.8% vs. 41.2%), multiorgan failures (60.4% vs. 73.3%), ACS (37.2% vs. 26.1%) and fatal outcome (33.3% vs. 13.0%) were also not significantly different between the pre-and postrevised guideline periods, respectively. In subgroup analysis, the mortality rates in patients with multiorgan failure (44.1% vs. 15.8%), acute respiratory failure and active bleeding (78.1% vs. 37.5%) and ACS (82.8% vs. 33.3%), respectively, were significantly higher in the pre-than the postrevised guideline periods. The durations of time before the liver function tests returned to normal levels, and the mortality rates in acute liver failure patients treated with and without N-acetyl cysteine were not significantly different. Conclusions: Although following the revised guidelines could not prevent organ failure, the mortality rates in patients with multiorgan failure and/or ACS decreased significantly when following the revised guidelines.

Prognostic values of serum lactate-to-bicarbonate ratio and lactate for predicting 28-day in-hospital mortality in children with dengue shock syndrome

“…The mortality rate of hospitalized children presenting with DSS has been reported to range from 1% to 36%. [2][3][4]7,8,22] In particular, a dramatically higher in-hospital mortality rate has been observed in patients with prolonged DSS, severe respiratory failure requiring MV, and PALF despite undergoing extracorporeal therapies. [4,5,7] In this study, we showed that the in-hospital fatality rate of all-type DSS-experiencing children was 5.3%.…”

“…[2] Complications associated with severe dengue, including prolonged dengue shock syndrome (DSS), severe bleeding, substantial plasma leakage, respiratory failure, and acute liver failure, predominantly contribute to the fatalities observed in hospitalized dengue children. [3][4][5][6][7][8] Lactic acidosis is associated with tissue hypoxia and is commonly observed in patients with DSS. The metabolic functions of the liver can be greatly affected by dengue-induced hepatic transaminases, which can manifest as increased serum lactate and decreased bicarbonate levels.…”

“…[2] Complications associated with severe dengue, including prolonged dengue shock syndrome (DSS), severe bleeding, substantial plasma leakage, respiratory failure, and acute liver failure, predominantly contribute to the fatalities observed in hospitalized dengue children. [3–8]…”

Características y errores más frecuentes en el diagnóstico y tratamiento del dengue en un hospital del norte peruano, 2022

“…Para la implementación de una guía es necesario valorar objetivamente cómo está el conocimiento y la práctica, y aplicar intervenciones educativas validadas. La adherencia a las guías mejora el actuar de los profesionales y los resultados clínicos (4,5) .…”

“…Debemos mencionar que se han encontrado dos capacitaciones brindadas por expertos durante la actual epidemia en Piura: la primera a 150 personas del primer nivel de Piura (6) y la segunda a personal de la Sub-Región de Salud Morropón-Huancabamba (7) . Sin embargo, además de brindar capacitaciones para el recurso humano, es necesario medir la línea de base (conocimientos, actitudes y prácticas) (5) y, posteriormente, determinar su impacto. En un estudio cuasi experimental hindú Balkrishnan et.al., demostraron que un programa educativo estructurado tuvo impacto en mejorar la clasificación, monitorización, fluido terapia, monitorización de hematocrito, disminución de mortalidad y estancia hospitalaria (8) .…”