Abstract
BackgroundThe increasing incidence and geographical distribution of dengue has had significant impact on global healthcare services and resources. This study aimed to determine the factors associated with dengue-related mortality in a cohort of Malaysian patients.MethodsThis was a retrospective cohort study of patients in the Malaysian National Dengue Registry of 2013. The outcome measure was dengue-related mortality. Associations between sociodemographic and clinical variables with the outcome were analysed using multivariate analysis.ResultsThere were 43 347 cases of which 13081 were serologically confirmed. The mean age was 30.0 years (SD 15.7); 60.2% were male. The incidence of dengue increased towards the later part of the calendar year. There were 92 probable dengue mortalities, of which 41 were serologically confirmed. Multivariate analysis in those with positive serology showed that increasing age (OR 1.03; CI:1.01–1.05), persistent vomiting (OR 13.34; CI: 1.92–92.95), bleeding (OR 5.84; CI 2.17–15.70) and severe plasma leakage (OR 66.68; CI: 9.13–487.23) were associated with mortality. Factors associated with probable dengue mortality were increasing age (OR 1.04; CI:1.03–1.06), female gender (OR 1.53; CI:1.01–2.33), nausea and/or vomiting (OR 1.80; CI:1.17–2.77), bleeding (OR 3.01; CI:1.29–7.04), lethargy and/or restlessness (OR 5.97; CI:2.26–15.78), severe plasma leakage (OR 14.72; CI:1.54–140.70), and shock (OR 1805.37; CI:125.44–25982.98), in the overall study population.ConclusionsOlder persons and those with persistent vomiting, bleeding or severe plasma leakage, which were associated with mortality, at notification should be monitored closely and referred early if indicated. Doctors and primary care practitioners need to detect patients with dengue early before they develop these severe signs and symptoms.
Highlights
Dengue is the most common and serious arthropod-borne viral disease
There were 92 probable dengue mortalities, of which 41 were serologically confirmed. Multivariate analysis in those with positive serology showed that increasing age, persistent vomiting, bleeding and severe plasma leakage were associated with mortality
Factors associated with probable dengue mortality were increasing age, female gender, nausea and/or vomiting, bleeding, lethargy and/or restlessness, severe plasma leakage, and shock, in the overall study population
Summary
Dengue is the most common and serious arthropod-borne viral disease. First reported in 1779 by David Bylon during an epidemic in Indonesia, there has been a dramatic expansion in disease distribution in the last 50 years [1]. Before 1970, only nine countries had dengue epidemics. Dengue is endemic in more than a hundred countries in five out of the six WHO regions [2]. 75% of the global dengue disease burden is in the WHO South East Asia and Western Pacific regions [3, 4]. The incidence rate of dengue in Malaysia had quadrupled from 44.3 cases/100 000 in 1999 to 181 cases/ 100 000 in 2007 [6] and the number of reported dengue cases has increased 6.5 fold in the last decade [7]. Vital resources including time, hospital beds, finances and personnel are diverted from other serious disease areas. The increasing incidence and geographical distribution of dengue has had significant impact on global healthcare services and resources. This study aimed to determine the factors associated with dengue-related mortality in a cohort of Malaysian patients
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