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.
Highlights
Dengue is an arbovirus recognized as a growing public health problem owing to its wide geographic dispersion and high incidence in various countries [1]
Considering the lack of information on the predictors of death due to dengue in the state of Amazonas and the importance of this information for decision making and the implementation of effective measures for patient care, this study aimed to identify factors associated with the occurrence of death among patients who presented with severe dengue in the Amazonas
We considered as severe dengue those confirmed cases recorded by SINAN presenting with the “final classification” variable filled out as “dengue with complications—DC”, “dengue hemorrhagic fever—DHF”, or “dengue shock syndrome—DSS”
Summary
Dengue is an arbovirus recognized as a growing public health problem owing to its wide geographic dispersion and high incidence in various countries [1]. 3,803 cases were confirmed and 9 deaths were reported to be caused by dengue in the state of Amazonas, where 1,658 cases were confirmed and 6 deaths occurred in its capital, Manaus [5]. The mortality and hospitalization rates due to dengue increased in several regions of the country [6,7]. It is noteworthy to highlight that the first dengue epidemic in the state of Amazonas occurred between the years 1998 and 1999 [8]. Since the introduction of the serotype DEN-2 in 2001, there has been an increase in the recording of severe cases and deaths from the disease [9,10]. In 2011, when the worst epidemic in the state occurred, the circulation of four serotypes was observed, with 57,805 confirmed cases and 23 deaths [11]
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