Clinical Indicators of Fatal Dengue in Two Endemic Areas of Colombia: A Hospital-Based Case-Control Study
Clinical Indicators of Fatal Dengue in Two Endemic Areas of Colombia: A Hospital-Based Case-Control Study
复制标题
DOI：
10.4269/ajtmh.17-0323
复制
发表时间：
2019-01-01
影响因子：
3.3
通讯作者：
Villar, Luis A.
中科院分区：
文献类型：
--
作者：
Rojas, Elsa M.;Herrera, Victor M.;Villar, Luis A.
根据世界卫生组织的数据，98%的致命登革热病例是可以预防的;然而，哥伦比亚等流行国家在最近的流行病中记录了更高的病死率。我们的目的是确定死亡率的预测因子，以便对登革热患者进行风险分层和及时干预。我们在哥伦比亚的两个流行区进行了一项以医院为基础的病例对照（1：2）研究（2009-2015）。致命病例定义为1）血清学检测（IgM或NS 1）阳性，2）病毒学检测（RT-PCR或病毒分离）阳性，或3）尸检结果与登革热死亡相符。对照组（按州和年份匹配）为住院的非致命性患者，血清学或病毒学登革热试验阳性。暴露数据由经过培训的工作人员从医疗记录中提取。我们在多重插补的背景下使用条件logistic回归（调整年龄，性别，疾病持续时间和医疗保健提供者）来估计暴露于病例对照协会。我们评估了110例病例和217例对照（平均年龄：35.0比18.9;入院前疾病持续时间：4.9比5.0天）。在多变量分析中，眼后疼痛（比值比[OR] = 0.23），恶心（OR = 0.29），腹泻（OR = 0.19）在致死性病例中的流行率低于非致死性病例，而年龄增加（OR = 2.46/10年），呼吸窘迫（OR = 16.3），意识障碍（OR = 15.9），黄疸（OR = 32.2），心率加快（OR = 2.01/10次/分钟）增加死亡的可能性（AUC：0.97，95%置信区间：0.96，0.99）。这些结果提供了证据表明，严重登革热的特征与较高的死亡率相关，这加强了与登革热流行地区患者分流有关的建议。
According to the World Health Organization, 98% of fatal dengue cases can be prevented; however, endemic countries such as Colombia have recorded higher case fatality rates during recent epidemics. We aimed to identify the predictors of mortality that allow risk stratification and timely intervention in patients with dengue. We conducted a hospital-based, case-control (1: 2) study in two endemic areas of Colombia (2009-2015). Fatal cases were defined as having either 1) positive serological test (IgM or NS1), 2) positive virological test (RT-PCR or viral isolation), or 3) autopsy findings compatible with death from dengue. Controls (matched by state and year) were hospitalized nonfatal patients and had a positive serological or virological dengue test. Exposure data were extracted from medical records by trained staff. We used conditional logistic regression (adjusting for age, gender, disease's duration, and health-care provider) in the context of multiple imputation to estimate exposure to case-control associations. Weevaluated 110 cases and 217 controls (mean age: 35.0 versus 18.9; disease's duration pre-admission: 4.9 versus 5.0 days). In multivariable analysis, retro-ocular pain (odds ratios [OR] = 0.23), nausea (OR = 0.29), and diarrhea (OR = 0.19) were less prevalent among fatal than nonfatal cases, whereas increased age (OR = 2.46 per 10 years), respiratory distress (OR = 16.3), impaired consciousness (OR = 15.9), jaundice (OR = 32.2), and increased heart rate (OR = 2.01 per 10 beats per minute) increased the likelihood of death (AUC: 0.97, 95% confidence interval: 0.96, 0.99). These results provide evidence that features of severe dengue are associated with higher mortality, which strengthens the recommendations related to triaging patients in dengue-endemic areas.