title: Dengue in Malaysia: Factors Associated with Dengue Mortality from a National Registry.
abstract: BACKGROUND
  The increasing incidence and geographical distribution of dengue has had significant impact on global healthcare services and resources. This study aimed to determine the factors associated with dengue-related mortality in a cohort of Malaysian patients.
  
  
  METHODS
  This was a retrospective cohort study of patients in the Malaysian National Dengue Registry of 2013. The outcome measure was dengue-related mortality. Associations between sociodemographic and clinical variables with the outcome were analysed using multivariate analysis.
  
  
  RESULTS
  There were 43 347 cases of which 13081 were serologically confirmed. The mean age was 30.0 years (SD 15.7); 60.2% were male. The incidence of dengue increased towards the later part of the calendar year. There were 92 probable dengue mortalities, of which 41 were serologically confirmed. Multivariate analysis in those with positive serology showed that increasing age (OR 1.03; CI:1.01-1.05), persistent vomiting (OR 13.34; CI: 1.92-92.95), bleeding (OR 5.84; CI 2.17-15.70) and severe plasma leakage (OR 66.68; CI: 9.13-487.23) were associated with mortality. Factors associated with probable dengue mortality were increasing age (OR 1.04; CI:1.03-1.06), female gender (OR 1.53; CI:1.01-2.33), nausea and/or vomiting (OR 1.80; CI:1.17-2.77), bleeding (OR 3.01; CI:1.29-7.04), lethargy and/or restlessness (OR 5.97; CI:2.26-15.78), severe plasma leakage (OR 14.72; CI:1.54-140.70), and shock (OR 1805.37; CI:125.44-25982.98), in the overall study population.
  
  
  CONCLUSIONS
  Older persons and those with persistent vomiting, bleeding or severe plasma leakage, which were associated with mortality, at notification should be monitored closely and referred early if indicated. Doctors and primary care practitioners need to detect patients with dengue early before they develop these severe signs and symptoms.
authors.affiliation: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
authors.forename: Su May
authors.initials: SM
authors.lastname: Liew
authors.affiliation: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
authors.forename: Ee Ming
authors.initials: EM
authors.lastname: Khoo
authors.affiliation: Klinik Kesihatan Bandar Botanik, Ministry of Health Malaysia, 42000 Klang, Malaysia.
authors.forename: Bee Kiau
authors.initials: BK
authors.lastname: Ho
authors.affiliation: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
authors.forename: Yew Kong
authors.initials: YK
authors.lastname: Lee
authors.affiliation: Klinik Kesihatan Kelana Jaya, Ministry of Health Malaysia, 47301 Petaling Jaya, Malaysia.
authors.forename: Mimi
authors.initials: M
authors.lastname: Omar
authors.affiliation: Klinik Kesihatan Taman Medan, Ministry of Health Malaysia, 46000 Petaling Jaya, Malaysia.
authors.forename: Vickneswari
authors.initials: V
authors.lastname: Ayadurai
authors.affiliation: Klinik Kesihatan Seksyen 19 Shah Alam, Ministry of Health Malaysia, 40300 Shah Alam, Malaysia.
authors.forename: Fazlina
authors.initials: F
authors.lastname: Mohamed Yusoff
authors.affiliation: Vector-Borne Disease Sector, Ministry of Health Malaysia, 62590 Putrajaya, Malaysia.
authors.forename: Zailiza
authors.initials: Z
authors.lastname: Suli
authors.affiliation: Vector-Borne Disease Sector, Ministry of Health Malaysia, 62590 Putrajaya, Malaysia.
authors.forename: Rose Nani
authors.initials: RN
authors.lastname: Mudin
authors.affiliation: National Clinical Research Center, Ministry of Health Malaysia, 50586 Kuala Lumpur, Malaysia.
authors.forename: Pik Pin
authors.initials: PP
authors.lastname: Goh
authors.affiliation: Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
authors.forename: Karuthan
authors.initials: K
authors.lastname: Chinna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003715:Dengue / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult