title: Nonhematological organ dysfunction and positive fluid balance are important determinants of outcome in adults with severe dengue infection: a multicenter study from India.
abstract: OBJECTIVE
  The purpose of the study was to explore determinants of outcome in adults with dengue hemorrhagic fever or dengue shock syndrome.
  
  
  METHODS
  We performed a multicenter, retrospective, observational study over a 2-year period in 3 intensive care units (ICUs) in Pune (India).
  
  
  RESULTS
  One hundred eighty-four adult patients were admitted to the ICU with a positive dengue immunoglobulin M test result; 43 met the World Health Organization criteria for dengue hemorrhagic fever or dengue shock syndrome. One patient who was transferred to another hospital and whose outcome was unknown was not included in the analysis. Of the 42 patients, 20 (48%) had multiorgan failure on ICU admission. The ICU mortality was 19% (8/42). Nonsurvivors were more likely than survivors to have cardiovascular (100% vs 12%), respiratory (88% vs 12%), or neurological (75% vs 12%) failure (all P < .01). Hematological failure was not associated with a higher risk of death. Cumulative fluid balance at 72 hours was more positive in nonsurvivors than in survivors (6.2 vs 3.5 L, P < .05). Serum albumin concentrations at ICU admission were lower in nonsurvivors than in survivors (2.9 ± 0.3 vs 3.4 ± 0.7 g/dL, P < .05).
  
  
  CONCLUSIONS
  In our cohort, outcome from severe dengue was primarily related to nonhematological organ failure. Low serum albumin concentration on ICU admission and a more positive fluid balance at 72 hours were also associated with worse outcomes.
authors: Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Belgium.
authors: Linda
authors: L
authors: Schmitz
authors: Prayag Hospital-Shree Medical Foundation, Pune, India.
authors: Shirish
authors: S
authors: Prayag
authors: Niramaya Hospital, Chinchwad, Pune, India.
authors: Sunitha
authors: S
authors: Varghese
authors: Deenanath Mangeshkar Hospital, Pune, India.
authors: Sameer
authors: S
authors: Jog
authors: Deenanath Mangeshkar Hospital, Pune, India.
authors: Pallavi
authors: P
authors: Bhargav-Patil
authors: Niramaya Hospital, Chinchwad, Pune, India.
authors: Ajit
authors: A
authors: Yadav
authors: Niramaya Hospital, Chinchwad, Pune, India.
authors: Deepak
authors: D
authors: Salunke
authors: Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Belgium. Electronic address: jlvincen@ulb.ac.be.
authors: Jean-Louis
authors: JL
authors: Vincent
mesh_terms: D000328:Adult; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007194:India / Q000453:epidemiology; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality / Q000821:virology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012709:Serum Albumin / Q000032:analysis; D019595:Severe Dengue / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance / Q000502:physiology*
chemical_list: D012709:Serum Albumin