Impact of renal failure on the outcome of dengue viral infection.
OBJECTIVE
In the 2002 dengue outbreak in Taiwan, some fatal cases had the underlying disease of renal failure (RF). Physicians faced difficulty in diagnosis and treatment of these patients; however, the impacts of RF on the clinical presentations and outcomes of dengue infection have not been reported previously.


METHODS
A retrospective review was conducted of medical records, clinical presentations, laboratory findings, and underlying diseases for all cases of dengue infection in a medical center. Characteristics and outcomes of dengue-infected patients with and without RF were compared.


RESULTS
From January 2002 through January 2003, 519 dengue-infected patients were enrolled, including 412 patients with classical dengue fever (DF) and 107 patients with dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS). Twelve patients died in this outbreak, and all had DHF/DSS. Twenty-one (4.0%) patients were defined as being in the RF group. The RF group had a higher mortality rate than non-RF group (28.6 versus 1.2%; P < 0.001). The severity of GFR impairment was associated with higher percentages of DHF/DSS (P = 0.029) and mortality (P < 0.001). Differences in symptoms/signs and laboratory abnormalities between DF and DHF/DSS were significant in the non-RF group but not apparent in the RF group.


CONCLUSIONS
The diagnosis and management of dengue infection among patients with RF must be cautious, because complicated clinical courses with a higher mortality rate were well observed.
Kuo
Mei-Chuan
MC
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan.
Lu
Po-Liang
PL
Chang
Jer-Ming
JM
Lin
Ming-Yen
MY
Tsai
Jih-Jin
JJ
Chen
Yen-Hsu
YH
Chang
Ko
K
Chen
Hung-Chun
HC
Hwang
Shang-Jyh
SJ
D000328:Adult; D003404:Creatinine / Q000097:blood; D003715:Dengue / Q000150:complications* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D019595:Severe Dengue / Q000150:complications* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
D003404:Creatinine