Management and outcomes of severe dengue patients presenting with sepsis in a tropical country.
Management and outcomes of severe dengue patients presenting with sepsis in a tropical country.
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DOI：
10.1371/journal.pone.0176233
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Limmathurotsakul D
中科院分区：
文献类型：
--
作者：
Teparrukkul P;Hantrakun V;Day NPJ;West TE;Limmathurotsakul D
登革热是热带国家成年人感染的常见原因。脓毒症是由任何生物体感染引起的全身表现的综合征；包括细菌、真菌和病毒制剂。在这里，我们在泰国社区获得性败血症的前瞻性研究中调查了出现败血症的登革热患者的诊断、治疗和结果。 2015 年 6 月至 12 月，对 874 名疑似或有记录的社区获得性感染的成年患者（年龄≥18 岁）进行了评估，根据 2012 年拯救脓毒症运动，其脓毒症诊断标准≥3 个，入院 24 小时内。储存血清并随后进行登革热 PCR 检测。共有 126 名患者登革热 PCR 检测呈阳性（2 名 DENV-1、12 名 DENV-2、24 名 DENV-3 和 88 名 DENV-4），其中 5 名（4%）死亡。我们发现，84 名患者（67%）在入院时主治医生怀疑感染登革热，96 名患者（76%）最终诊断为登革热感染。五名死亡病例中有四人被诊断为败血性休克并接受治疗，而非登革热。多变量分析显示，年龄≥60岁、低氧血症和主治医师误诊登革热与28天死亡率相关。许多死于登革热的成年患者被误诊为严重脓毒症和感染性休克。仅根据临床特征诊断登革热是很困难的。热带国家出现败血症和败血性休克的成年患者可能需要常规使用登革热快速诊断检测。这种方法可以改善这些患者的诊断和管理。
Dengue is a common cause of infection in adults in tropical countries. Sepsis is a syndrome of systemic manifestations induced by infection of any organisms; including bacterial, fungal and viral agents. Here, we investigated the diagnosis, management and outcomes of dengue patients presenting with sepsis in a prospective study of community-acquired sepsis in Thailand. From June to December 2015, 874 adult patients (age≥18 years) with suspected or documented community-acquired infection, with ≥3 diagnostic criteria for sepsis according to the Surviving Sepsis Campaign 2012, and within 24 hours of admission were evaluated. Serum was stored and later tested for dengue PCR assays. A total of 126 patients had dengue PCR assays positive (2 DENV-1, 12 DENV-2, 24 DENV-3 and 88 DENV-4), and 5 of them (4%) died. We found that attending physicians suspected dengue infection on admission in 84 patients (67%), and recorded dengue infection as the final diagnosis in 96 patients (76%). Four of five fatal cases were diagnosed and treated as septic shock not due to dengue. In multivariable analysis, there was a trend showing that age≥60 years, hypoxemia and misdiagnosis of dengue by attending physicians were associated with 28-day mortality. A number of adult patients who died of dengue are misdiagnosed as severe sepsis and septic shock. Diagnosis of dengue based on clinical features alone is difficult. Rapid diagnostic tests for dengue may need to be routinely used in adult patients presenting with sepsis and septic shock in tropical countries. This approach could improve diagnosis and management of those patients.