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. 2016 Jun 23;11(6):e0157631.
doi: 10.1371/journal.pone.0157631. eCollection 2016.

Dengue in Malaysia: Factors Associated with Dengue Mortality from a National Registry

Su May Liew  1 , Ee Ming Khoo  1 , Bee Kiau Ho  2 , Yew Kong Lee  1 , Mimi Omar  3 , Vickneswari Ayadurai  4 , Fazlina Mohamed Yusoff  5 , Zailiza Suli  6 , Rose Nani Mudin  6 , Pik Pin Goh  7 , Karuthan Chinna  8
Affiliations

Dengue in Malaysia: Factors Associated with Dengue Mortality from a National Registry

Su May Liew et al. PLoS One. .

Abstract

Background: The increasing incidence and geographical distribution of dengue has had significant impact on global healthcare services and resources. This study aimed to determine the factors associated with dengue-related mortality in a cohort of Malaysian patients.

Methods: This was a retrospective cohort study of patients in the Malaysian National Dengue Registry of 2013. The outcome measure was dengue-related mortality. Associations between sociodemographic and clinical variables with the outcome were analysed using multivariate analysis.

Results: There were 43 347 cases of which 13081 were serologically confirmed. The mean age was 30.0 years (SD 15.7); 60.2% were male. The incidence of dengue increased towards the later part of the calendar year. There were 92 probable dengue mortalities, of which 41 were serologically confirmed. Multivariate analysis in those with positive serology showed that increasing age (OR 1.03; CI:1.01-1.05), persistent vomiting (OR 13.34; CI: 1.92-92.95), bleeding (OR 5.84; CI 2.17-15.70) and severe plasma leakage (OR 66.68; CI: 9.13-487.23) were associated with mortality. Factors associated with probable dengue mortality were increasing age (OR 1.04; CI:1.03-1.06), female gender (OR 1.53; CI:1.01-2.33), nausea and/or vomiting (OR 1.80; CI:1.17-2.77), bleeding (OR 3.01; CI:1.29-7.04), lethargy and/or restlessness (OR 5.97; CI:2.26-15.78), severe plasma leakage (OR 14.72; CI:1.54-140.70), and shock (OR 1805.37; CI:125.44-25982.98), in the overall study population.

Conclusions: Older persons and those with persistent vomiting, bleeding or severe plasma leakage, which were associated with mortality, at notification should be monitored closely and referred early if indicated. Doctors and primary care practitioners need to detect patients with dengue early before they develop these severe signs and symptoms.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Number of dengue cases in Malaysia between December 2012-December 2013.
* All months are in 2013 unless otherwise stated.
See this image and copyright information in PMC

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