Abstract
Background and Objective:Dengue infection has evolved into an epidemic during last few years in Pakistan and has been associated with poor outcomes. Literature with respect to mortality risk factors in Dengue infection is not sufficient. This compelled us to conduct this study to find out major contributory factors to death in patients with dengue viral infection at one of Asia’s ancient hospital setting with an aim to recognize complications at earliest and improve case management in future.Methods:A retrospective observational study of 95 adult dengue deaths was performed at Mayo Hospital Lahore from July 1st 2011 to 31st December 2011 during a major dengue epidemic. Patients who tested positive by dengue IgM in the presence of acute fever fulfilling the World Health Organization criteria for Dengue Fever, Dengue Hemorrhagic Fever or Dengue Shock Syndrome and died within same setting, were included. Data regarding demographic profile, clinical and laboratory parameters along with treatment details were obtained and analysed. All records examined were anonymized.Results:Median age was 36 years (range13-80 years) among 95 deaths due to Dengue. Male gender comprised 60 (63.1%). Co-morbidities existed in 74 (77.9%) with hypertension in 21 (22.1%) diabetes in 11 (11.58%), liver disease in 9 (9.47%) and ischemic heart disease in 8(8.4%) cases. Patients presented at second day of fever for admission (range 1-8 days) and death occurred at a median of 4 days (range 30 minutes to 23 days). Hospital stay was for less than a week for seventy nine (83.2%) patients and 16 (16.8%) were admitted for more than 7 days. Critical care was required in 67(71%). Severe hepatitis occurred in 41 (43.1%), acute renal impairment occurred in 32 (33.7%) and disseminated intravascular coagulation in 16 (16.8%). Deaths were due to prolonged shock 49 (51.5%) fluid overload 46 (48.4%) and massive bleeding 18(19%) leading to organ failure.Conclusion:Decompensated shock complicated by either massive plasma leakage, frank bleeding, multi organ failure or deranged clotting profile results in enhanced mortality in Dengue infection. Co-morbidities especially Diabetes are poor prognostic factors in predicting Dengue mortality.
Highlights
3.6 billion people residing in the tropics and subtropics are affected by Dengue Infection.[1]
A recent study done in a tertiary care setting showed that there is a rise in number of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) cases in Pakistan.[4]
According to WHO guidelines dengue fever (DF) clinically required the presence of fever and two or more of clinical signs or symptoms including headache, retro-orbital pain, myalgia, arthralgia, rash, hemorrhagic manifestations and leukopenia; DHF was labelled if DF patients had thrombocytopenia ≤100 ×10^9/L, any bleeding, and plasma leakage manifesting as either hematocrit change of ≥20%, fluid accumulation detected clinically or radiologically in the form of pleural effusion or ascites
Summary
3.6 billion people residing in the tropics and subtropics are affected by Dengue Infection.[1]. Pakistan and Sri Lanka have greater chunk of people suffering from this infection.[3] A recent study done in a tertiary care setting showed that there is a rise in number of DHF and DSS cases in Pakistan.[4]. People are more prone to have severe form of illness as reported in study done in Taiwan.[9] Another study conducted in Cuba documented that DF and DHF has increase mortality rates in extremes of ages.[10] A study done in Singapore showed that dengue infection in presence of chronic illness such as chronic renal failure or chronic pulmonary obstructive disease were likely to have poor outcome.[11] Secondary bacteremia was associated with high mortality rates as per study done in Taiwan[9]. We conducted this study to find out major contributory factors to death in patients with dengue infection at a tertiary care center with an aim to improve case management in future
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