Abstract
The purpose of our study was to describe the clinical profile of dengue-infected patients admitted to Brazilian intensive care units (ICU) and evaluate factors associated with death. A longitudinal, multicenter case series study was conducted with laboratory-confirmed dengue patients admitted to nine Brazilian ICUs situated in Minas Gerais state, southeastern Brazil from January 1, 2008, to December 31, 2013. Demographic, clinical and laboratory data; disease severity scores; and mortality were evaluated. A total of 97 patients were studied. The in-ICU and in-hospital mortality rates were 18.6% and 19.6%, respectively. Patients classified as having severe dengue according to current World Health Organization classifications showed an increased risk of death in a univariate analysis. Nonsurvivors were older, exhibited lower serum albumin concentrations and higher total leukocyte counts and serum creatinine levels. Other risk factors (vomiting, lethargy/restlessness, dyspnea/respiratory distress) were also associated with death in a univariate analysis. Multivariate analysis indicated that in-hospital mortality was significantly associated with Acute Physiology and Chronic Health Evaluation II and the Sequential Organ Failure Assessment score. The ICU and in-hospital mortality observed in this study were higher than values reported in similar studies. An increased frequency of ICU admission due to severe organ dysfunction, higher severity indices and scarcity of ICU beds may partially explain the higher mortality.
Highlights
Dengue is the most important arbovirosis in the world, with 2.5 billion people at risk and 50 million new cases every year
The purpose of our study was to describe the clinical profile of dengue-infected patients admitted to Brazilian intensive care units (ICU) and evaluate factors associated with death
To the best of our knowledge, our study is one of few to focus on dengue patients admitted to ICUs and the first of these studies to be conducted in Brazil
Summary
Dengue is the most important arbovirosis in the world, with 2.5 billion people at risk and 50 million new cases every year. The World Health Organization (WHO) estimates that twenty thousand people die from dengue every year [1,2]. The country has experienced an expansion of basic health assistance over the last 20 years, but there are still tertiary care centers that lack a sufficient number of hospital beds [7]. In developing countries, such as Brazil, where ICU beds can be a limited health resource, understanding the causes of dengue admissions and deaths could improve the management of critical dengue patients
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