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Meta-Analysis
. 2024 Mar;29(3):173-191.
doi: 10.1111/tmi.13968. Epub 2024 Jan 23.

Risk factors associated with severe dengue in Latin America: A systematic review and meta-analysis

Victoria Cruz Paraná  1   2 , Caroline Alves Feitosa  1 , Greice Carolina Santos da Silva  2 , Luana Leandro Gois  1   3 , Luciane Amorim Santos  1   2   4
Affiliations
Free article
Meta-Analysis

Risk factors associated with severe dengue in Latin America: A systematic review and meta-analysis

Victoria Cruz Paraná et al. Trop Med Int Health. 2024 Mar.
Free article

Abstract

Objective: Severe dengue is a significant health problem in Latin America, with children being the most affected. Understanding risk factors for severe dengue is crucial for enhancing patient care. Therefore, this study aims to systematically review the literature to identify the risk factors associated with severe dengue in Latin America through systematic review and meta-analysis.

Methods: PubMed, SciELO, LILACS and EMBASE databases were used to search for eligible scientific articles for the review. The outcomes considered were symptoms of severe dengue, hospitalisation and death. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the quality of the studies. Data analysis was performed using STATA v 13.0 software. The degree of heterogeneity between studies was quantified using the I2 measure, and statistically significant results were defined as those with p values <0.05.

Results: Of the 1876 articles screened, 47 articles were included in the systematic review and 45 articles were analysed through meta-analysis. Identified risk factors associated with severe dengue included secondary dengue infection, female sex, white or Caucasian ethnicity and specific signs and symptoms such as headache, myalgia and/or arthralgia, vomiting/nausea, abdominal pain or tenderness, diarrhoea, prostration, lethargy, fatigue or similar. For the death outcome, respiratory symptoms and age <18 years were identified as risk factors. On the other hand, in women, the diagnosis of positive tourniquet test, platelet count <100,000 per μL and symptoms of capillary fragility were associated with a lower probability of death. These data highlight the importance of early screening of patients, to identify possible haemorrhagic signs and reduce deaths from dengue. This study has limitations, including possible publication bias, heterogeneity of results and study design biases.

Conclusion: These findings are significant for shaping strategies, management approaches and identifying high-risk groups, which will help establish future guidelines.

Keywords: Latin America; dengue; risk factors; systematic review or meta-analysis.

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