title: Risk factors of mortality among dengue patients admitted to a tertiary care setting in Kerala, India.
abstract: Dengue is one of the most serious and rapidly emerging tropical mosquito-borne diseases. The state of Kerala in India is hyperendemic for the disease and is one of the leading states in the reporting of deaths due to dengue. As primary prevention of dengue has had limited success, the prevention of mortality through the identification of risk factors and efficient patient management is of utmost importance. Hence, a record-based case control study was conducted in the Medical College Hospital in Thiruvananthapuram to identify the risk factors of mortality in patients admitted with dengue. Dengue patients over 40years of age were 9.3 times (95% CI; 1.9-44.4) more likely to die compared with younger patients. The clinical features associated with mortality from dengue were altered sensorium (odds ratio (OR) - 156, 95% CI; 12.575-1935.197), abnormal reflexes (OR - 8.5, 95% CI; 1.833-39.421) and edema (OR - 13.22, 95% CI; 2.651-65.951). Mortality was also higher in those patients with co-morbidities such as diabetes mellitus (OR - 26, 95% CI; 2.47-273.674) and hypertension (OR - 44, 95% CI; 6.23-315.499). The independent predictors of mortality were altered sensorium and hypertension. Dengue fever patients with these clinical features and those who are elderly should be more rigorously monitored and promptly referred from lower settings when required to reduce mortality.
authors.affiliation: Department of Community Medicine, Medical College, Thiruvananthapuram, Kerala, India.
authors.forename: Aswath
authors.initials: A
authors.lastname: Karunakaran
authors.affiliation: Department of Community Medicine, Medical College, Thiruvananthapuram, Kerala, India.
authors.forename: Waseem Mohammed
authors.initials: WM
authors.lastname: Ilyas
authors.affiliation: Department of Community Medicine, Medical College, Thiruvananthapuram, Kerala, India.
authors.forename: S F
authors.initials: SF
authors.lastname: Sheen
authors.affiliation: Department of Community Medicine, Medical College, Thiruvananthapuram, Kerala, India.
authors.forename: Nelson K
authors.initials: NK
authors.lastname: Jose
authors.affiliation: Department of Community Medicine, Medical College, Thiruvananthapuram, Kerala, India. Electronic address: drzinia@gmail.com.
authors.forename: Zinia T
authors.initials: ZT
authors.lastname: Nujum
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003715:Dengue / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D063128:Tertiary Health Care; D055815:Young Adult
keywords: Dengue; Kerala; Mortality; Risk factors; Thiruvananthapuram