title: Factors associated with death from dengue in the state of Minas Gerais, Brazil: historical cohort study.
abstract: OBJECTIVE
  To analyse the clinical and epidemiological profiles of dengue haemorrhagic fever (DHF), dengue shock syndrome (DSS) and complicated dengue cases and deaths from 2008 to 2010 that occurred in the state of Minas Gerais, south-eastern Brazil, and to identify factors associated with death from dengue.
  
  
  METHODS
  Historical cohort study using data from the Brazilian Information System for Notifiable Diseases. A descriptive analysis of the DHF, DSS and complicated dengue cases and deaths was performed; the incidence, mortality and case-fatality rates were estimated. Logistic regression analysis was used to identify factors associated with death from dengue. Comorbidities were not included in the analysis because the information system does not contain such data.
  
  
  RESULTS
  During the study period, 2214 DHF, DSS and complicated dengue cases were reported, including 156 deaths. The annual case-fatality rates for DHF/DSS and complicated dengue cases in the period of 2008-2010 were 7.3%, 4.8% and 7.9%, respectively. The factors associated with death from dengue included residence in a municipality with a population of fewer than 100,000 inhabitants [odds ratio (OR) 2.46; 95% confidence interval (CI) 1.71-3.55], age over 65 years (OR 3.05; 95% CI 1.99-4.68) and plasma leakage (OR 1.69; 95% CI 1.16-2.46).
  
  
  CONCLUSIONS
  The results support the importance of plasma leakage as a warning sign associated with death from dengue as well as the signs and symptoms that allow the diagnosis of DHF. Moreover, our findings suggest that increased attention is necessary for individuals over 65 years of age and in municipalities with populations under 100,000 inhabitants to ensure a better quality of care during the management of severe patients of dengue in these locations. Differences in the interpretation of the DHF definition have hindered the comparison of data from different countries; it can improve from the WHO 2009 dengue classification.
authors.affiliation: Programa de Pós-Graduação em Ciências da Saúde, Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Coordenação Geral do Programa Nacional de Controle da Dengue, Departamento de Vigilância das Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil.
authors.forename: Kauara Brito
authors.initials: KB
authors.lastname: Campos
authors.forename: Frederico Figueiredo
authors.initials: FF
authors.lastname: Amâncio
authors.forename: Valdelaine Etelvina Miranda
authors.initials: VE
authors.lastname: de Araújo
authors.forename: Mariângela
authors.initials: M
authors.lastname: Carneiro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D019595:Severe Dengue / Q000401:mortality*; D055815:Young Adult
keywords: Brasil; Brazil; Brésil; case-fatality rate; dengue fever; dengue haemorrhagic fever; dengue shock syndrome; facteurs associés au décès; factores asociados con la muerte; factors associated with death; fiebre del dengue; fiebre hemorrágica del dengue; fièvre dengue; fièvre hémorragique de la dengue; perte de plasma; plasma leakage; pérdida de plasma; syndrome de choc de la dengue; síndrome de choque por dengue; tasa de letalidad; taux de létalité