Dengue infection with multiorgan dysfunction: SOFA score, arterial lactate and serum albumin levels are predictors of outcome

Jog, Sameer; Prayag, Shirish; Rajhans, Prasad; Zirpe, Kapil; Dixit, Subhal; Pillai, Lalitha V.; Shah, Jignesh; Penurkar, Mukund; Kakrani, Arjun; Yadav, Ajit Kumar; Kadapatti, Kayanoosh; Pawar, Balasaheb; Salunke, Deepak B.; Joshi, Pramod S.; Deshpande, Aniruddh V.; Gurav, Sushma; Patel, Daywin

doi:10.1007/s00134-015-4024-6

Cited by 17 publications

(15 citation statements)

References 4 publications

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“…We enrolled only patients with severe dengue in the present study and found that CRP was a limited outcome predictor in patients with severe dengue. We also found that albumin levels were significantly lower (2.8 ± 0.6 vs 3.1 ± 0.5) and lactate significantly higher (6.2 ± 6.7 vs 2.4 ± 1.9) in patients who died than in survivors, which was consistent with other studies [ 17 , 28 ] that low serum albumin levels on ICU admission were associated with worse outcomes. Although a multivariate analysis eliminated the significance in our study, it still indicates an association between albumin levels and the outcomes in patients with severe dengue.…”

Section: Discussionsupporting

confidence: 92%

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The outcomes of patients with severe dengue admitted to intensive care units

Chen

Chan

et al. 2016

Medicine

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Outcomes of adult patients with dengue infections requiring intensive care unit (ICU) admissions remain unclear. We assessed the clinical manifestations and prognostic factors of patients critically ill with severe dengue.This retrospective study was done in a tertiary referral hospital with 96 adult ICU beds. All of the patients with laboratory-confirmed severe dengue infections and admitted to the ICU were enrolled between July 31 and November 31, 2015, during the large outbreak period. The medical records of all the recruited patients were reviewed for the following information: age, gender, clinical manifestations, disease severity scores, underlying conditions, laboratory examinations, and outcomes. The primary endpoint was to find the predictors of ICU mortality.During the study period, 4787 patients with dengue infections required ICU admission. One hundred forty-three (2.99%) were critically ill (mean age: 69.7 years). Hypertension (n = 90, 62.9%) and diabetes mellitus (n = 70, 49.0%) were the 2 most common underlying diseases. Eighty critically ill patients (55.9%) had cobacterial infections, and 33 had cobacteremia. The hematologic system failed most often, followed by thoracic and cardiovascular systems. Fever was the most common presentation (n = 112; 78.3%), followed by anorexia (n = 47; 32.9%) and abdominal pain (n = 46; 32.2%). Overall, 33 patients died (mortality rate: 23.1%). Multivariate analysis showed that ICU mortality was significantly associated with lower Glasgow Coma Scale (GCS) scores, lower platelet counts before ICU discharge, and more organ failures.The number of severe dengue patients who require ICU admission remains high. The mortality rate was associated with lower GCS scores, lower platelet counts, and more organ failures. In addition, more than half of the critically ill dengue patients had comorbid bacterial infections.

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Section: Discussionsupporting

confidence: 92%

“…Third, we did not test the serotypes of dengue virus because our laboratory cannot do that type of examination. However, several studies [ 28 – 31 ] have reported the association between dengue virus serotypes and the severity of dengue infection. Our findings should help clarify this association.…”

Section: Discussionmentioning

confidence: 99%

The outcomes of patients with severe dengue admitted to intensive care units

Chen

Chan

et al. 2016

Medicine

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“…In addition, hypoalbuminemia and high serum lactate level have been associated with high mortality [38]. In our elderly cohort, AKI, cardiac arrest before ICU admission, and prolonged APTT were independent predictive factors for in-hospital fatality.…”

Section: Discussionmentioning

confidence: 81%

A Cohort Study of Adult Patients with Severe Dengue in Taiwanese Intensive Care Units: The Elderly and APTT Prolongation Matter for Prognosis

et al. 2017

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BackgroundThere was a large dengue outbreak in Taiwan in 2015, in which the ages of the affected individuals were higher than those in other countries. The aim of this study was to explore the characteristics and prognostic factors for adults with severe dengue in intensive care units (ICUs).MethodsAll adults admitted to ICUs with dengue virus infection (DENV) at a medical center from July 1, 2015 to December 31, 2015 were enrolled. DENV was diagnosed by the presence of serum NS1 antigen, IgM antibodies to dengue virus, or dengue virus RNA by real-time reverse transcriptase polymerase chain reaction. Demographic data, clinical features, and lab data were collected, and a multivariate Cox model was used to identify the predictive factors for in-hospital mortality.ResultsSeventy-five patients admitted to ICUs with laboratory-confirmed DENV were enrolled (mean age 72.3±9.3 years). The most common comorbidities included hypertension (72.0%), diabetes (43.7%), and chronic kidney disease (22.7%). The in-hospital case fatality rate (CFR) was 41.3%. The patients who died were predominantly female, had higher disease severity at ICU admission, shorter ICU/hospital stay, longer initial activated partial thromboplastin time (APTT), and higher initial serum aspartate transaminase levels. Cardiac arrest before ICU admission (hazard ratio [HR]: 6.26 [1.91–20.54]), prolonged APTT (>48 seconds; HR: 3.91 [1.69–9.07]), and the presence of acute kidney injury on admission (HR: 2.48 [1.07–5.74]), were independently associated with in-hospital fatality in the Cox multivariate analysis.ConclusionDuring the 2015 dengue outbreak in Taiwan, the patients with severe dengue in ICUs were characterized by old age, multiple comorbidities, and a high CFR. Organ failure (including cardiac failure, and renal failure) and coagulation disturbance (prolongation of initial APTT) were independent predictive factors for in-hospital fatality.

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“…26 This was similar to the results published by Jog et al in 2015. 27 It was also concluded that patients with Multiple Organ dysfunction (MODS) had a higher mortality compared to those who didn't (p value <0.001). …”

Section: -35mentioning

confidence: 99%

Predictors of mortality in adult patients with dengue: a study from South India

et al. 2018

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Background: Dengue is one of the important causes of acute febrile illnesses in India. Dengue can be a fatal disease, however there are no reliable markers which can predict mortality among these patients.Methods: A prospective cross sectional study was done in patients who were admitted to a tertiary care hospital with features of dengue fever. A total of 364 patients with IgM dengue serology positive were included in the study. Relevant clinical and laboratory parameters were collected from all patients. Association between clinico-laboratory parameters with mortality was studied using appropriate statistical methods.Results: Among the 364 patients recruited in this study, 14 (3.85%) patients died. Mortality among patients with age group 18-40 years was 2.04%, in patients aged above 40 years was 7.56%. Mortality among patients with hypotension was 42.42% (14 out of 33), bleeding manifestations was 15.38% (8/52), platelets <20,000/mm3 was 10.41% (10/96), ALT >200 was 13.04% (6/46), AST>200 was 12.34% (10/81), prolonged prothrombin time was 60%(12/20), renal failure was 28%(14/50), encephalopathy was 31.57% (6/19), multi organ dysfunction syndrome(MODS) was 43.33% (13/30), acute respiratory distress syndrome (ARDS) was 45.45% (5/11), pleural effusion was 7.5% (6/80).Conclusions: The overall mortality in the present study was 3.85%. Following variables were associated with increased risk of death among the dengue patients: Age >40 years, presence of hypotension, platelets <20000 cells/mm3, ALT>200U/L, AST>200U/L, prolonged prothrombin time, presence of renal failure, encephalopathy, MODS, ARDS and bleeding tendency (p value <0.05). Early identification of factors associated with mortality can help to make appropriate decision on care required.

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Dengue infection with multiorgan dysfunction: SOFA score, arterial lactate and serum albumin levels are predictors of outcome

Cited by 17 publications

References 4 publications

The outcomes of patients with severe dengue admitted to intensive care units

The outcomes of patients with severe dengue admitted to intensive care units

A Cohort Study of Adult Patients with Severe Dengue in Taiwanese Intensive Care Units: The Elderly and APTT Prolongation Matter for Prognosis

Predictors of mortality in adult patients with dengue: a study from South India

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