Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden.
Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden.
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斯里兰卡面临严重登革热风险的儿童和成人的结果：疾病负担高的国家进行门诊病例管理的机会。
DOI：
10.1371/journal.pntd.0010091
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发表时间：
2021-12
影响因子：
3.8
通讯作者：
Tillekeratne LG
中科院分区：
文献类型：
--
作者：
Bodinayake CK;Nagahawatte AD;Devasiri V;Dahanayake NJ;Wijayaratne GB;Weerasinghe NP;Premamali M;Sheng T;Nicholson BP;Ubeysekera HA;Kurukulasooriya RM;de Silva AD;Østbye T;Woods CW;Tillekeratne LG
由于根据登革热管理指南住院的患者数量很多，登革热流行国家的医疗保健系统经常不堪重负。我们系统地评估了一大批急性登革热住院患者的临床结果，以支持未来将患者分流到门诊和住院治疗。从2017年6月至2018年12月，我们对在斯里兰卡南部省最大的三级护理医院(床位1800张)住院的儿童和成人进行了监测，他们在前7天内发烧。出现血小板计数≤100,000/μL(斯里兰卡入院门槛)并符合至少两项与登革热一致的临床标准的患者有资格参加。我们通过检测登记时收集的血清检测登革热NS1抗原或IgM抗体来确认急性登革热。我们根据1997年和2009年世界卫生组织(WHO)的分类标准定义了主要结果：登革热出血热(DHF；世卫组织1997年)、登革热休克综合征(DSS；世卫组织1997年)和严重登革热(WHO 2009)。总体而言，1064名患者被确诊为急性登革热：NS1快速抗原检测318例(17.4%)，IgM抗体检测746例(40.7%)。在1064例患者中，994例(93.4%)为18岁的成人≥，704例(66.2%)为男性。大多数(56，80%)儿童和超过一半的成人(544，54.7%)在住院期间发展为DHF，而6(8.6%)儿童和22(2.2%)成人发展为DSS。总体而言，10名(14.3%)儿童和113名(11.4%)成年人患上了严重登革热。共有2名患者(0.2%)在住院期间死亡。在住院的急性登革热患者中，有一半进展为DHF，极少数人发展为DSS或严重登革热。在登革热流行国家，开发一种将患者分流到门诊和住院管理的算法应该是优化医疗资源利用的未来目标。在登革热流行的国家，由于登革热流行期间大量病人入院，医院往往不堪重负。我们研究了斯里兰卡1064名因急性登革热住院的儿童和成人，以确定严重疾病后果的流行率，以支持开发一种可以限制未来住院的系统。我们发现，只有一半的患者在住院期间出现了严重的疾病后果，只有一小部分患者出现了危及生命的疾病。对于登革热流行的国家，应优先发展识别无需住院即可管理的急性登革热患者的系统。
Healthcare systems in dengue-endemic countries are often overburdened due to the high number of patients hospitalized according to dengue management guidelines. We systematically evaluated clinical outcomes in a large cohort of patients hospitalized with acute dengue to support triaging of patients to ambulatory versus inpatient management in the future. From June 2017- December 2018, we conducted surveillance among children and adults with fever within the prior 7 days who were hospitalized at the largest tertiary-care (1,800 bed) hospital in the Southern Province, Sri Lanka. Patients who developed platelet count ≤100,000/μL (threshold for hospital admission in Sri Lanka) and who met at least two clinical criteria consistent with dengue were eligible for enrollment. We confirmed acute dengue by testing sera collected at enrollment for dengue NS1 antigen or IgM antibodies. We defined primary outcomes as per the 1997 and 2009 World Health Organization (WHO) classification criteria: dengue hemorrhagic fever (DHF; WHO 1997), dengue shock syndrome (DSS; WHO 1997), and severe dengue (WHO 2009). Overall, 1064 patients were confirmed as having acute dengue: 318 (17.4%) by NS1 rapid antigen testing and 746 (40.7%) by IgM antibody testing. Of these 1064 patients, 994 (93.4%) were adults ≥18 years and 704 (66.2%) were male. The majority (56, 80%) of children and more than half of adults (544, 54.7%) developed DHF during hospitalization, while 6 (8.6%) children and 22 (2.2%) adults developed DSS. Overall, 10 (14.3%) children and 113 (11.4%) adults developed severe dengue. A total of 2 (0.2%) patients died during hospitalization. One-half of patients hospitalized with acute dengue progressed to develop DHF and a very small number developed DSS or severe dengue. Developing an algorithm for triaging patients to ambulatory versus inpatient management should be the future goal to optimize utilization of healthcare resources in dengue-endemic countries. In countries where dengue is prevalent, hospitals are often overwhelmed due to the high numbers of patient admissions during dengue epidemics. We studied 1064 children and adults hospitalized with acute dengue in Sri Lanka to determine the prevalence of severe disease outcomes to support the development of a system which can limit hospitalizations in the future. We found that only half of patients developed severe disease outcomes during hospitalization and only a small minority of patients developed life-threatening disease. For dengue-prevalent countries, developing systems to identify patients with acute dengue who can be managed without hospital admission should be a priority.
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10.1590/0037-8682-0036-2018
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2018-12-01
影响因子：
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