Impaired Consciousness, Acute Respiratory Distress Syndrome (ARDS), and Multiorgan Dysfunction Syndrome (MODS) As the Triad of Mortality in Severe Dengue: Evidence From 100 Consecutive ICU Admissions.

Background Severe dengue is a leading contributor to intensive care unit (ICU) admissions and death in tropical regions. Identifying factors associated with poor outcomes early is critical for guiding treatment and allocating resources in critically ill patients. Methods This prospective observational cohort enrolled 100 consecutive patients with WHO 2009-defined severe dengue admitted to the ICU and Emergency Department of Maharishi Markandeshwar Institute of Medical Science and Research (MMIMSR), Mullana, Haryana, between March 2025 and January 2026. Clinical, laboratory, and severity-score data (Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA)) were recorded and compared between survivors and non-survivors using appropriate statistical tests, relative risks (RR) with 95% CI, and ROC analysis. Results The mean age was 47.2 ± 17.5 years; 58% were male. ICU mortality was 21.0% (21/100). Thrombocytopenia showed no mortality link (p = 0.678). Higher pulse rate, respiratory rate, body temperature, total leucocyte count, creatinine, bilirubin, and lactate, together with lower blood pressure, Glasgow Coma scale (GCS) score, arterial pH, and PaO2, were each associated with ICU mortality (all p < 0.05). Among warning signs, only hepatomegaly >2 cm was significant (50.0% vs. 17.0% mortality; RR 2.93, 95% CI 1.41-6.09; p = 0.024). Impaired consciousness (72.4% vs. 0% mortality; RR 103.20, 95% CI 6.46-1649.18; p < 0.001), acute respiratory distress syndrome (ARDS; 100% vs. 12.2%; RR 7.55, 95% CI 4.33-13.16; p < 0.001), and multiorgan dysfunction syndrome (MODS; 76.9% vs. 12.6%; RR 6.08, 95% CI 3.25-11.39; p = 0.002) showed the strongest associations (φ = 0.807, 0.647, 0.531 respectively). APACHE II (AUC 0.935) and SOFA (AUC 0.938) had the best discriminative accuracy, followed by lactate (AUC 0.835) and arterial pH (AUC 0.824). Conclusions Impaired consciousness, ARDS, and MODS strongly predicted mortality in this severe dengue cohort, forming a clinically vital cluster for early risk stratification. These single-center findings question the thrombocytopenia-centric paradigm and support closer attention to neurological status and organ dysfunction from ICU admission onward.