Predictors of hospital stay and mortality in dengue virus infection-experience from Aga Khan University Hospital Pakistan

Abstract

BackgroundDengue virus infection (DVI) is very common infection. There is scarcity of data on factor associated with increased hospital stay and mortality in dengue virus infection (DVI). This study was done to know about factors associated with increased hospital stay and mortality in patients admitted with DVI.ResultsOut of 532 patients, two third (72.6%) had stay ≤3 days while one third (27.4%) had stay greater than 3 days. The mean length of hospital stay was 3.46 ± 3.45 days. Factors associated with increased hospital stay (>3 days) included AKI (acute kidney injury) (Odd ratio 2.98; 95% CI 1.66-5.34), prolonged prothrombin time (Odd ratio 2.03; 95% CI 1.07-3.84), prolonged activated partial thromboplastin time (aPTT) (Odd ratio 1.80; CI 95% 1.15-2.83) and increased age of > 41.10 years (Odd ratio 1.03; CI 95% 1.01-1.04).Mortality was 1.5%. High mortality was found in those with AKI (P <0.01), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) (P <0.001), respiratory failure (P0.01), prolong PT (P 0.001), prolong aPTT (P0.01) and increased hospital stay (P0.04).ConclusionIncreasing age, coagulopathy and acute kidney injury in patients with DVI is associated with increased hospital stay. Morality was more in patients with AKI, DHF and DSS, respiratory failure, coagulopathy and these patients had more prolonged hospitalization.

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

“…There is evidence from available literature showing an association between mortality and various clinical, biochemical and haematological parameters like haematocrit, prothrombin time, activated partial thromboplastin time, lactate levels, acute kidney injury and ARDS. [6][7][8][9] In our study, there was no relation of mortality with gender of the patients. Males constituted 64% of the 14 deaths (p value = 0.534).…”

“…Similar results were observed by Khalil et al, in their study conducted in Pakistan and other studies. 8,23,24 The presence of altered sensorium and abnormal reflexes is indicative of CNS involvement in the form of encephalopathy. As evidenced in this study and suggested in several other studies, brain involvement is associated with a higher incidence of mortality in dengue patients (p value <0.001).…”

“…Case fatality rate due to dengue reported from most countries is less than 5% but in absence of early recognition and proper management it may go high. [5][6][7][8][9] Early identification of the risk factors associated with mortality, would help clinicians prioritise the management of high-risk patients to reduce morbidity and mortality.…”

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

“…Old age, acute renal failure, acute respiratory failure, acute hepatitis, DSS/DHF, altered mental status, bleeding, and coagulopathy have been reported to be predictive factors for fatality in the patients with DF [19–21]. In addition, hypoalbuminemia and high serum lactate level have been associated with high mortality [38].…”

“…Various predictive factors for mortality have been identified in DF, including old age, acute renal injury, acute respiratory failure, hepatitis, altered mental status, bleeding and coagulopathy [19–21]. The acute physiology and chronic health evaluation (APACHE) II score may predict mortality in patients admitted to an intensive care unit (ICU) in a prospective observational cohort study [22].…”