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PLoS One. 2014 Dec 2;9(12):e114499. doi: 10.1371/journal.pone.0114499. eCollection 2014.

Acute respiratory failure and active bleeding are the important fatality predictive factors for severe dengue viral infection.

Author information

1
Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
2
Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.

Abstract

OBJECTIVE:

To determine the outcome of severe dengue viral infection (DVI) and the main dengue fatality risk factors.

STUDY DESIGN:

The medical records of patients aged <15 years admitted to Songklanagarind Hospital in southern Thailand during 1989-2011 were reviewed. Patients who had dengue hemorrhagic fever (DHF) grades III-IV, organ failure (cardiovascular, respiratory, liver, renal or hematologic), impaired consciousness, or aspartate aminotransferase more than 1,000 units/L, were classified as having severe DVI. To determine the fatality risk factors of severe DVI, the classification trees were constructed based on manual recursive partitioning.

RESULTS:

Of the 238 children with severe DVI, 30 (12.6%) died. Compared to the non-fatal DVI cases, the fatal cases had higher rates of DHF grade IV (96.7% vs 24.5%), repeated shock (93.3% vs 27.9%), acute respiratory failure (ARF) (100% vs 6.7%), acute liver failure (ALF) (96.6% vs 6.3%), acute kidney injury (AKI) (79.3% vs 4.5%), and active bleeding requiring blood transfusion (93.3% vs 5.4%), all p<0.01. The combined risk factors of ARF and active bleeding considered together predicted fatal outcome with sensitivity, specificity, and negative and positive predictive values of 0.93 (0.78-0.99), 0.97 (0.93-0.99), 0.99 (0.97-1.00), and 0.82 (0.65-0.93), respectively. The likelihood ratios for a fatal outcome in the patients who had and did not have this risk combination were 32.4 (14.6-71.7) and 0.07 (0.02-0.26), respectively.

CONCLUSION:

Severe DVI patients who have ARF and active bleeding are at a high risk of death, while patients without these things together should survive.

PMID:
25460594
PMCID:
PMC4252142
DOI:
10.1371/journal.pone.0114499
[Indexed for MEDLINE]
Free PMC Article

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