Diabetic patients suffering dengue are at risk for development of dengue shock syndrome/severe dengue: Emphasizing the impacts of co-existing comorbidity(ies) and glycemic control on dengue severity
Diabetic patients suffering dengue are at risk for development of dengue shock syndrome/severe dengue: Emphasizing the impacts of co-existing comorbidity(ies) and glycemic control on dengue severity
复制标题
DOI：
10.1016/j.jmii.2017.12.005
复制
发表时间：
2020-02-01
影响因子：
7.4
通讯作者：
Liu, Jien-Wei
中科院分区：
文献类型：
--
作者：
Lee, Ing-Kit;Hsieh, Ching-Jung;Liu, Jien-Wei
背景/目的：2型糖尿病（DM2）对登革热临床严重程度的影响尚不完全清楚。我们的目的是评估登革出血热(DHF)/登革休克综合征（DSS）和严重登革热（SD）（根据世界卫生组织1997年和2009年登革热分类定义）的危险因素，并在DM2患者中确定有发生登革出血热/DSS和严重登革热风险的患者。方法：对2002 ~ 2010年诊断的登革热患者进行回顾性分析。采用多因素分析确定DHF/DSS/SD发展的危险因素。为了阐明共存的合并症（即高血压、慢性肾病、老年性卒中和/或缺血性心脏病）和血糖控制对DM2患者登革热临床结局的影响，将有或无合并症的总体DM2患者和分层DM2患者（HbA1c < 7% vs HbA1c >= 7%）分别与对照组（无任何发病率的患者）进行比较。结果：767例患者（146例DM2和621例对照组）中，1.4%发生DSS， 3.3%发生SD。虽然DM2是DSS（校正优势比[AOR] = 7.473； 95%可信区间[CI] = 2.2241 -25.146）和SD （AOR = 6.207; 95% CI = 2.464-15.636）的独立危险因素，但只有伴有额外合病（ies）和血糖控制不理想（HbA1c >= 7%）的DM2患者的非休克DHF （60.8% vs. 29%）、DSS （8.7% vs. 0.8%）和SD （34.8% vs. 1.1%）的发生率显著较高。结论：这些数据有助于将高危DM2登革热患者的分诊目标缩小到血糖控制不佳和并存合并症的患者。版权所有：台湾省微生物学会爱思唯尔台湾有限责任公司出版。
Background/Purpose: The impact of type 2 diabetes mellitus (DM2) on clinical severity of dengue has not been fully understood. We aimed to assess risk factors for dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS) and severe dengue (SD) (defined based on the World Health Organization 1997 and 2009 dengue classifications), and additionally identify, among DM2 patients, who are at risk for developing DHF/DSS and severe dengue.Methods: A retrospective analysis of dengue patients diagnosed between 2002 and 2010. Risk factors for development of DHF/DSS/SD were identified using multivariate analysis. To elucidate the impacts of coexisting comorbidity(ies) (i.e., hypertension, chronic kidney disease, old stroke, and/or ischemic heart disease) and glycemic control on clinical outcomes of dengue in DM2 patients, the overall DM2 patients and stratified DM2 patients (HbA1c < 7% vs. HbA1c >= 7%), with or without comorbidity(ies), were separately compared to controls (patients without any morbidity).Results: Of 767 (146 DM2 and 621 controls) included patients, 1.4% suffered DSS and 3.3% SD. While DM2 was an independent risk factor for DSS (adjusted odds ratio [AOR] = 7.473; 95% confidence interval [CI] = 2.221-25.146) and SD (AOR = 6.207; 95% CI = 2.464-15.636), only DM2 patients with additional comorbidity(ies) and suboptimal glycemic control (HbA1c >= 7%) had significantly higher incidences of non- shock DHF (60.8% vs. 29%), DSS (8.7% vs. 0.8%) and SD (34.8% vs. 1.1%).Conclusions: These data could help narrow down the number of targets in the triage for risky DM2 dengue patients to those with suboptimal glycemic control and co-existing comorbidity(ies). Copyright (C) 2018, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC.