Mortality Predictors in Patients with Severe Dengue in the State of Amazonas, Brazil

Rosemary Costa Pinto; Daniel Barros de Castro; Bernardino Cláudio de Albuquerque; Vanderson de Souza Sampaio; Ricardo Augusto Dos Passos; Cristiano Fernandes da Costa; Megumi Sadahiro; José Ueleres Braga

doi:10.1371/journal.pone.0161884

Mortality Predictors in Patients with Severe Dengue in the State of Amazonas, Brazil

PLoS One. 2016 Aug 26;11(8):e0161884. doi: 10.1371/journal.pone.0161884. eCollection 2016.

Affiliations

¹ Health Surveillance Foundation of Amazonas State (Fundação de Vigilância em Saúde do Amazonas, FVS), Manaus, Brazil.
² Sérgio Arouca National School of Public Health (Escola Nacional de Saúde Pública Sérgio Arouca), FIOCRUZ, Rio de Janeiro, Brazil.
³ Laboratory of Physiology and Control of Arthropod Vectors (Laboratório de Fisiologia e Controle de Artrópodes Vetores), Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil.
⁴ Institute of Social Medicine (Instituto de Medicina Social), Rio de Janeiro State University (Universidade do Estado do Rio de Janeiro, UERJ), Rio de Janeiro, Brazil.
⁵ PECTI-SAÚDE/Research Foundation of the State of Amazonas (Fundação de Amparo à Pesquisa do Estado do Amazonas, FAPEAM), Manaus, Brazil.

Abstract

Dengue is a major public health problem in tropical and subtropical areas worldwide. There is a lack of information on the risk factors for death due to severe dengue fever in developing countries, including Brazil where the state of Amazonas is located. This knowledge is important for decision making and the implementation of effective measures for patient care. This study aimed to identify factors associated with death among patients with severe dengue, in Amazonas from 2001 to 2013. We conducted a retrospective cohort study based on secondary data from the epidemiological surveillance of dengue provided by the Fundação de Vigilância em Saúde do Amazonas, FVS (Health Surveillance Foundation) of the Secretaria de Saúde do Amazonas, SUSAM (Health Secretariat of the State of Amazonas). Data on dengue cases were obtained from the SINAN (Notifiable Diseases Information System) and SIM (Mortality Information System) databases. We selected cases of severe dengue with laboratory confirmation, including dengue-related deaths of residents in the state of Amazonas from January 1, 2001, to December 31, 2013. The explanatory variables analyzed were sex, age, level of education, spontaneous hemorrhagic manifestations, plasma extravasation and platelet count. Patients who died due to severe dengue had more hematuria, gastrointestinal bleeding, and thrombocytopenia than the survivors. Considering the simultaneous effects of demographic and clinical characteristics with a multiple logistic regression model, it was observed that the factors associated with death were age >55 years (odds ratio [OR] 4.98), gastrointestinal bleeding (OR 10.26), hematuria (OR 5.07), and thrombocytopenia (OR 2.55). Gastrointestinal bleeding was the clinical sign most strongly associated with death, followed by hematuria and age >55 years. The study results showed that the best predictor of death from severe dengue is based on the characteristic of age >55 years, together with the clinical signs of gastrointestinal bleeding, hematuria, and low platelet count.

MeSH terms

Adolescent
Adult
Brazil / epidemiology
Disease Outbreaks
Female
Humans
Logistic Models
Male
Middle Aged
Odds Ratio
Retrospective Studies
Risk Factors
Severe Dengue / epidemiology*
Severe Dengue / mortality*
Severity of Illness Index
Young Adult

Grants and funding

This work was supported by the government of the state of Amazonas, through the Fundação de Amparo à Pesquisa do Estado do Amazonas, FAPEAM (Research Foundation of the State of Amazonas), for granting scholarships by the RH-Doctoral Program (DBC has a fellowship) and publishing support by Journal Articles Publishing Support Program (PAPAC number 015/2014). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.