Risk factors associated with death in Brazilian children with severe dengue: a case-control study.
OBJECTIVE
The purpose of this case-control study was to evaluate risk factors associated with death in children with severe dengue.


METHODS
The clinical condition of hospitalized patients with severe dengue who died (cases, n = 18) was compared with that of hospitalized patients with severe dengue who survived (controls, n = 77). The inclusion criteria for this study were age under 13 years; hospital admission in São Luis, northeastern Brazil; and laboratory-confirmed diagnosis of dengue.


RESULTS
Severe bleeding (hemoptysis), a defining criterion for dengue severity, was the factor most strongly associated with death in our study. We also found that epistaxis and persistent vomiting, both included as warning signs in the World Health Organization (WHO) classification of dengue, were strongly associated with death. No significant association was observed between any of the laboratory findings and death.


CONCLUSIONS
The finding that epistaxis and persistent vomiting were also associated with death in children with severe dengue was unexpected and deserves to be explored in future studies. Because intensive care units are often limited in resource-poor settings, any information that can help to distinguish patients with severe dengue with a higher risk to progress to death may be crucial.
Departamento de Patologia, Universidade Federal do Maranhão, São Luís/MA, Brazil, Universidade Federal do Maranha˜ o, Departamento de Patologia, Sa˜o Luı´s/MA, Brazil.
Maria dos Remédios Freitas Carvalho
Mdos R
Branco
Departamento de Moléstias Infecciosas e Parasitárias (LIMHC), Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo/SP, Brazil, Universidade de Sa˜o Paulo, Instituto de Medicina Tropical de Sa˜o Paulo, Departamento de Mole´ stias Infecciosas e Parasita´ rias (LIMHC), Sa˜o Paulo/SP, Brazil.
Expedito José de Albuquerque
EJ
Luna
Hospital da Universidade Federal do Maranhão, São Luís/MA, Brazil, Hospital da Universidade Federal do Maranha˜o, Sa˜o Luı´s/MA, Brazil.
Leônidas Lopes
LL
Braga Júnior
Hospital da Universidade Federal do Maranhão, São Luís/MA, Brazil, Hospital da Universidade Federal do Maranha˜o, Sa˜o Luı´s/MA, Brazil.
Ricardo Villar Barbosa de
RV
Oliveira
Hospital da Universidade Federal do Maranhão, São Luís/MA, Brazil, Hospital da Universidade Federal do Maranha˜o, Sa˜o Luı´s/MA, Brazil.
Lívia Teresa Moreira
LT
Rios
Vigilância Epidemiológica Municipal de São Luís, São Luís/MA, Brazil, Vigilância Epidemiológica Municipal de São Luı´s, Sa˜o Luı´s/MA, Brazil.
Maria do Socorro da
Mdo S
Silva
Vigilância Epidemiológica Municipal de São Luís, São Luís/MA, Brazil, Vigilância Epidemiológica Municipal de São Luı´s, Sa˜o Luı´s/MA, Brazil.
Maria Nilza Lima
MN
Medeiros
Departamento de Patologia, Universidade Federal do Maranhão, São Luís/MA, Brazil, Universidade Federal do Maranha˜ o, Departamento de Patologia, Sa˜o Luı´s/MA, Brazil.
Gilnara Fontinelle
GF
Silva
Departamento de Patologia, Universidade Federal do Maranhão, São Luís/MA, Brazil, Universidade Federal do Maranha˜ o, Departamento de Patologia, Sa˜o Luı´s/MA, Brazil.
Fernanda Campos Amaral Figueiredo
FC
Nina
Departamento de Patologia, Universidade Federal do Maranhão, São Luís/MA, Brazil, Universidade Federal do Maranha˜ o, Departamento de Patologia, Sa˜o Luı´s/MA, Brazil.
Taliane Jardim
TJ
Lima
Departamento de Patologia, Universidade Federal do Maranhão, São Luís/MA, Brazil, Universidade Federal do Maranha˜ o, Departamento de Patologia, Sa˜o Luı´s/MA, Brazil.
Jayron Alves
JA
Brito
Departamento de Patologia, Universidade Federal do Maranhão, São Luís/MA, Brazil, Universidade Federal do Maranha˜ o, Departamento de Patologia, Sa˜o Luı´s/MA, Brazil.
Avessandra Costa Cardoso de
AC
Oliveira
Departamento de Moléstias Infecciosas e Parasitárias (LIMHC), Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo/SP, Brazil, Universidade de Sa˜o Paulo, Instituto de Medicina Tropical de Sa˜o Paulo, Departamento de Mole´ stias Infecciosas e Parasita´ rias (LIMHC), Sa˜o Paulo/SP, Brazil.
Claudio Sergio
CS
Pannuti
D000293:Adolescent; D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D060888:Real-Time Polymerase Chain Reaction; D012307:Risk Factors; D019595:Severe Dengue / Q000097:blood / Q000150:complications / Q000401:mortality*; D012720:Severity of Illness Index