title: Acute respiratory failure and active bleeding are the important fatality predictive factors for severe dengue viral infection.
abstract: OBJECTIVE
  To determine the outcome of severe dengue viral infection (DVI) and the main dengue fatality risk factors.
  
  
  METHODS
  The medical records of patients aged <15 years admitted to Songklanagarind Hospital in southern Thailand during 1989-2011 were reviewed. Patients who had dengue hemorrhagic fever (DHF) grades III-IV, organ failure (cardiovascular, respiratory, liver, renal or hematologic), impaired consciousness, or aspartate aminotransferase more than 1,000 units/L, were classified as having severe DVI. To determine the fatality risk factors of severe DVI, the classification trees were constructed based on manual recursive partitioning.
  
  
  RESULTS
  Of the 238 children with severe DVI, 30 (12.6%) died. Compared to the non-fatal DVI cases, the fatal cases had higher rates of DHF grade IV (96.7% vs 24.5%), repeated shock (93.3% vs 27.9%), acute respiratory failure (ARF) (100% vs 6.7%), acute liver failure (ALF) (96.6% vs 6.3%), acute kidney injury (AKI) (79.3% vs 4.5%), and active bleeding requiring blood transfusion (93.3% vs 5.4%), all p<0.01. The combined risk factors of ARF and active bleeding considered together predicted fatal outcome with sensitivity, specificity, and negative and positive predictive values of 0.93 (0.78-0.99), 0.97 (0.93-0.99), 0.99 (0.97-1.00), and 0.82 (0.65-0.93), respectively. The likelihood ratios for a fatal outcome in the patients who had and did not have this risk combination were 32.4 (14.6-71.7) and 0.07 (0.02-0.26), respectively.
  
  
  CONCLUSIONS
  Severe DVI patients who have ARF and active bleeding are at a high risk of death, while patients without these things together should survive.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Kamolwish
authors.initials: K
authors.lastname: Laoprasopwattana
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Wanwipa
authors.initials: W
authors.lastname: Chaimongkol
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Pornpimol
authors.initials: P
authors.lastname: Pruekprasert
authors.affiliation: Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Alan
authors.initials: A
authors.lastname: Geater
mesh_terms: D002648:Child; D003715:Dengue / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006470:Hemorrhage / Q000150:complications*; D006801:Humans; D008297:Male; D012131:Respiratory Insufficiency / Q000150:complications*; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology