Predictive factors of dengue severity in hospitalized children and adolescents in Rio de Janeiro, Brazil
Predictive factors of dengue severity in hospitalized children and adolescents in Rio de Janeiro, Brazil
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DOI：
10.1590/0037-8682-0036-2018
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发表时间：
2018-12-01
影响因子：
2
通讯作者：
Oliveira, Solange Artimos de
中科院分区：
文献类型：
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作者：
Ferreira, Ralph Antonio Xavier;Kubelka, Claire Fernandes;Oliveira, Solange Artimos de
简介：登革热是最重要的蚊媒传染病之一。严重病例在成人中更常见。然而，在2008年，巴西里约热内卢州经历了严重的登革热流行，主要影响儿童，并造成许多登革出血热病例和死亡。研究方法：进行了一项横断面分析研究，以检查2008年1月至6月在巴西里约热内卢市一家市立医院确诊的16岁以下登革热病例的实验室诊断和临床流行病学因素。与严重结局相关的变量和P值小于0.05通过logistic回归模型进行评估。结果：在研究的419例登革热病例中，296例被归类为登革出血热，123例被归类为经典登革热。6例DHF患者死亡。在多变量分析中，一些实验室和临床变量与DHF独立相关：年龄5岁或以上（比值比[OR]，4.94; 95%置信区间[CI]，1.30-18.71），腹痛（OR，8.59; 95%CI，3.17-23.27）、肝肿大（OR，15.87; 95%CI，5.38-46.85）和止血带试验阳性（OR，10.84; 95%CI，3.96-29.71）。在DHF病例中，低白蛋白血症的发生率高于血液浓缩，高转氨酶水平与严重程度相关。结论：年龄大于5岁、腹痛、疼痛性肝肿大和止血带试验阳性是DHF的预测因素。肝损害的高频率表明，在登革热的严重病例中应避免使用对乙酰氨基酚。
Introduction: Dengue is one of the most important mosquito-borne infections. Severe cases are more frequently observed in adults. However, in 2008, the State of Rio de Janeiro, Brazil, experienced a severe dengue epidemic that primarily affected children and caused many cases of dengue hemorrhagic fever (DHF) and death. Methods: A cross-sectional analytical study was conducted to examine laboratory diagnosis and clinical epidemiologic factors for confirmed dengue cases in patients aged less than 16 years, from January to June 2008, at a municipal hospital in the City of Rio de Janeiro, Brazil. Variables associated with severe outcomes and P values less than .05 were evaluated by means of a logistic regression model. Results: Of the 419 dengue cases studied, 296 were classified as DHF and 123 as classical dengue. Six patients who had DHF died. In multivariate analysis, some laboratory and clinical variables were independently associated with DHF: age 5 years or older (odds ratio [OR], 4.94; 95% confidence interval [CI], 1.30-18.71), abdominal pain (OR, 8.59; 95% CI, 3.17-23.27), hepatomegaly (OR, 15.87; 95% CI, 5.38-46.85), and positive tourniquet test (OR, 10.84; 95% CI, 3.96-29.71). Hypoalbuminemia occurred more frequently than hemoconcentration in DHF cases, and high aminotransferase levels were associated with severity. Conclusions: Age greater than 5 years, abdominal pain, painful hepatomegaly, and positive tourniquet test were predictors of DHF. The high frequency of hepatic impairment suggests that acetaminophen should be avoided in severe cases of dengue.