Mortality Predictors in Patients with Severe Dengue in the State of Amazonas, Brazil
Mortality Predictors in Patients with Severe Dengue in the State of Amazonas, Brazil
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DOI：
10.1371/journal.pone.0161884
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发表时间：
2016-08-26
期刊：
影响因子：
3.7
通讯作者：
Braga, Jose Ueleres
中科院分区：
文献类型：
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作者：
Pinto, Rosemary Costa;de Castro, Daniel Barros;Braga, Jose Ueleres
登革热是全球热带和亚热带地区的一个主要公共卫生问题。在发展中国家，包括亚马逊州所在的巴西，缺乏关于严重登革热导致死亡的危险因素的信息。这方面的知识是重要的决策和实施有效措施的病人护理。本研究旨在确定2001年至2013年亚马逊地区严重登革热患者死亡的相关因素。我们根据亚马孙省卫生监测基金会、亚马孙省秘书处卫生监测基金会FVS和亚马孙州卫生秘书处SUSAM提供的登革热流行病学监测的二手数据开展了一项回顾性队列研究。登革热病例数据来自应通报疾病信息系统（SINAN）和死亡率信息系统（SIM）数据库。我们选取了2001年1月1日至2013年12月31日亚马逊州经实验室确认的重症登革热病例，包括与登革热相关的居民死亡病例。分析的解释变量为性别、年龄、文化程度、自发性出血表现、血浆外渗和血小板计数。因严重登革热而死亡的患者比幸存者有更多的血尿、胃肠道出血和血小板减少症。考虑到人口统计学和临床特征的同时影响，采用多元logistic回归模型观察到与死亡相关的因素为年龄（比值比[OR] 4.98）、胃肠道出血（比值比[OR] 10.26）、血尿（比值比[OR] 5.07）和血小板减少（比值比[OR] 2.55）。胃肠道出血是与死亡最密切相关的临床症状，其次是血尿和年龄在55岁以下。研究结果显示，重症登革热患者死亡的最佳预测指标是年龄在50 ~ 55岁之间，并伴有胃肠道出血、血尿和低血小板计数的临床症状。
Dengue is a major public health problem in tropical and subtropical areas worldwide. There is a lack of information on the risk factors for death due to severe dengue fever in developing countries, including Brazil where the state of Amazonas is located. This knowledge is important for decision making and the implementation of effective measures for patient care. This study aimed to identify factors associated with death among patients with severe dengue, in Amazonas from 2001 to 2013. We conducted a retrospective cohort study based on secondary data from the epidemiological surveillance of dengue provided by the Fundacao de Vigilancia em Saude do Amazonas, FVS (Health Surveillance Foundation) of the Secretaria de Saude do Amazonas, SUSAM (Health Secretariat of the State of Amazonas). Data on dengue cases were obtained from the SINAN (Notifiable Diseases Information System) and SIM (Mortality Information System) databases. We selected cases of severe dengue with laboratory confirmation, including dengue-related deaths of residents in the state of Amazonas from January 1, 2001, to December 31, 2013. The explanatory variables analyzed were sex, age, level of education, spontaneous hemorrhagic manifestations, plasma extravasation and platelet count. Patients who died due to severe dengue had more hematuria, gastrointestinal bleeding, and thrombocytopenia than the survivors. Considering the simultaneous effects of demographic and clinical characteristics with a multiple logistic regression model, it was observed that the factors associated with death were age >55 years (odds ratio [OR] 4.98), gastrointestinal bleeding (OR 10.26), hematuria (OR 5.07), and thrombocytopenia (OR 2.55). Gastrointestinal bleeding was the clinical sign most strongly associated with death, followed by hematuria and age >55 years. The study results showed that the best predictor of death from severe dengue is based on the characteristic of age >55 years, together with the clinical signs of gastrointestinal bleeding, hematuria, and low platelet count.