International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2026
Factors associated with death in severe dengue: a retrospective cohort study in Espírito Santo, Brazil, 2020-2024.
СтатьяНазвание и аннотация: Перевод в очереди
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Vicente Creuza Rachel, Cola João Paulo, Brioschi Dos Santos Ana Paula, Cardoso Theresa Cristina, Cerutti Junior Crispim, Ooi Eng Eong, Gobbi Stefano, Luch Dos Santos Julia, Espinosa Miranda Angelica, Chan Kuan Rong
Аннотация
OBJECTIVE: To identify factors associated with death among patients with severe dengue.
METHODS: We conducted a population-based retrospective cohort study including all laboratory-confirmed severe dengue cases reported in Espírito Santo, Brazil, between 2020 and 2024. Participants were classified according to the recorded outcome as fatal or non-fatal severe dengue cases.
RESULTS: Among 251 laboratory-confirmed severe dengue cases, 117 (46.6%) resulted in death. Fatal cases were significantly older than survivors. In the overall multivariable model, weak or undetectable pulse (RR, 1.74; 95% CI: 1.34-2.26), late-stage arterial hypotension (RR, 1.80; 95% CI: 1.34-2.42), progressive increase in hematocrit (RR, 1.43; 95% CI: 1.10-1.85), and altered level of consciousness (RR, 1.31; 95% CI: 1.02-1.67) were associated with a higher risk of death. Conversely, fever (RR, 0.72; 95% CI: 0.56-0.92) and a sudden drop in platelet count (RR, 0.76; 95% CI: 0.59-0.91) were associated with a lower risk of death. In the exploratory age-stratified analyzes, weak or undetectable pulse and late-stage arterial hypotension remained associated with a higher risk of death in both age groups, while progressive increase in hematocrit and sudden platelet drop were associated with death only among individuals aged <60 years, and fever was associated with a lower risk of death only among those aged ≥60 years.
CONCLUSION: Mortality in severe dengue is predominantly associated with markers of advanced hemodynamic instability rather than early warning signs, particularly among older adults.
METHODS: We conducted a population-based retrospective cohort study including all laboratory-confirmed severe dengue cases reported in Espírito Santo, Brazil, between 2020 and 2024. Participants were classified according to the recorded outcome as fatal or non-fatal severe dengue cases.
RESULTS: Among 251 laboratory-confirmed severe dengue cases, 117 (46.6%) resulted in death. Fatal cases were significantly older than survivors. In the overall multivariable model, weak or undetectable pulse (RR, 1.74; 95% CI: 1.34-2.26), late-stage arterial hypotension (RR, 1.80; 95% CI: 1.34-2.42), progressive increase in hematocrit (RR, 1.43; 95% CI: 1.10-1.85), and altered level of consciousness (RR, 1.31; 95% CI: 1.02-1.67) were associated with a higher risk of death. Conversely, fever (RR, 0.72; 95% CI: 0.56-0.92) and a sudden drop in platelet count (RR, 0.76; 95% CI: 0.59-0.91) were associated with a lower risk of death. In the exploratory age-stratified analyzes, weak or undetectable pulse and late-stage arterial hypotension remained associated with a higher risk of death in both age groups, while progressive increase in hematocrit and sudden platelet drop were associated with death only among individuals aged <60 years, and fever was associated with a lower risk of death only among those aged ≥60 years.
CONCLUSION: Mortality in severe dengue is predominantly associated with markers of advanced hemodynamic instability rather than early warning signs, particularly among older adults.