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Multicenter Study
. 2015 Jun 19;10(6):e0129046.
doi: 10.1371/journal.pone.0129046. eCollection 2015.

Clinical Profiles and Factors Associated with Death in Adults with Dengue Admitted to Intensive Care Units, Minas Gerais, Brazil

Frederico Figueiredo Amâncio  1 , Tiago Pires Heringer  2 , Cristina da Cunha Hueb Barata de Oliveira  3 , Liliane Boaventura Fassy  4 , Frederico Bruzzi de Carvalho  5 , Daniela Pagliari Oliveira  6 , Claudio Dornas de Oliveira  7 , Fernando Otoni Botoni  8 , Fernanda do Carmo Magalhães  9 , José Roberto Lambertucci  10 , Mariângela Carneiro  11
Affiliations
Multicenter Study

Clinical Profiles and Factors Associated with Death in Adults with Dengue Admitted to Intensive Care Units, Minas Gerais, Brazil

Frederico Figueiredo Amâncio et al. PLoS One. .

Abstract

The purpose of our study was to describe the clinical profile of dengue-infected patients admitted to Brazilian intensive care units (ICU) and evaluate factors associated with death. A longitudinal, multicenter case series study was conducted with laboratory-confirmed dengue patients admitted to nine Brazilian ICUs situated in Minas Gerais state, southeastern Brazil from January 1, 2008, to December 31, 2013. Demographic, clinical and laboratory data; disease severity scores; and mortality were evaluated. A total of 97 patients were studied. The in-ICU and in-hospital mortality rates were 18.6% and 19.6%, respectively. Patients classified as having severe dengue according to current World Health Organization classifications showed an increased risk of death in a univariate analysis. Nonsurvivors were older, exhibited lower serum albumin concentrations and higher total leukocyte counts and serum creatinine levels. Other risk factors (vomiting, lethargy/restlessness, dyspnea/respiratory distress) were also associated with death in a univariate analysis. Multivariate analysis indicated that in-hospital mortality was significantly associated with Acute Physiology and Chronic Health Evaluation II and the Sequential Organ Failure Assessment score. The ICU and in-hospital mortality observed in this study were higher than values reported in similar studies. An increased frequency of ICU admission due to severe organ dysfunction, higher severity indices and scarcity of ICU beds may partially explain the higher mortality.

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Conflict of interest statement

Competing Interests: The authors declare that they have no significant competing financial, professional or personal interests that might have influenced the performance or presentation of the work described in this manuscript.

Figures

Fig 1
Fig 1. APACHE II score, SOFA score, total leukocyte count and serum albumin concentration AUROCs.
Fig 2
Fig 2. Number of patients in the WHO 1997 and 2009 dengue classifications according to SOFA and APACHE II scores.
DF: dengue fever; DHF I & II: dengue hemorrhagic fever grade I and II; DHF III & IV: dengue hemorrhagic fever grade III and IV; DWS: dengue with warning signs; SD: severe dengue.
See this image and copyright information in PMC

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