title: Mortality Predictors in Patients with Severe Dengue in the State of Amazonas, Brazil.
abstract: Dengue is a major public health problem in tropical and subtropical areas worldwide. There is a lack of information on the risk factors for death due to severe dengue fever in developing countries, including Brazil where the state of Amazonas is located. This knowledge is important for decision making and the implementation of effective measures for patient care. This study aimed to identify factors associated with death among patients with severe dengue, in Amazonas from 2001 to 2013. We conducted a retrospective cohort study based on secondary data from the epidemiological surveillance of dengue provided by the Fundação de Vigilância em Saúde do Amazonas, FVS (Health Surveillance Foundation) of the Secretaria de Saúde do Amazonas, SUSAM (Health Secretariat of the State of Amazonas). Data on dengue cases were obtained from the SINAN (Notifiable Diseases Information System) and SIM (Mortality Information System) databases. We selected cases of severe dengue with laboratory confirmation, including dengue-related deaths of residents in the state of Amazonas from January 1, 2001, to December 31, 2013. The explanatory variables analyzed were sex, age, level of education, spontaneous hemorrhagic manifestations, plasma extravasation and platelet count. Patients who died due to severe dengue had more hematuria, gastrointestinal bleeding, and thrombocytopenia than the survivors. Considering the simultaneous effects of demographic and clinical characteristics with a multiple logistic regression model, it was observed that the factors associated with death were age >55 years (odds ratio [OR] 4.98), gastrointestinal bleeding (OR 10.26), hematuria (OR 5.07), and thrombocytopenia (OR 2.55). Gastrointestinal bleeding was the clinical sign most strongly associated with death, followed by hematuria and age >55 years. The study results showed that the best predictor of death from severe dengue is based on the characteristic of age >55 years, together with the clinical signs of gastrointestinal bleeding, hematuria, and low platelet count.
authors: Health Surveillance Foundation of Amazonas State (Fundação de Vigilância em Saúde do Amazonas, FVS), Manaus, Brazil.
authors: Rosemary Costa
authors: RC
authors: Pinto
authors: Health Surveillance Foundation of Amazonas State (Fundação de Vigilância em Saúde do Amazonas, FVS), Manaus, Brazil.|Sérgio Arouca National School of Public Health (Escola Nacional de Saúde Pública Sérgio Arouca), FIOCRUZ, Rio de Janeiro, Brazil.
authors: Daniel Barros de
authors: DB
authors: Castro
authors: Health Surveillance Foundation of Amazonas State (Fundação de Vigilância em Saúde do Amazonas, FVS), Manaus, Brazil.
authors: Bernardino Cláudio de
authors: BC
authors: Albuquerque
authors: Health Surveillance Foundation of Amazonas State (Fundação de Vigilância em Saúde do Amazonas, FVS), Manaus, Brazil.
authors: Vanderson de Souza
authors: Vde S
authors: Sampaio
authors: Health Surveillance Foundation of Amazonas State (Fundação de Vigilância em Saúde do Amazonas, FVS), Manaus, Brazil.|Laboratory of Physiology and Control of Arthropod Vectors (Laboratório de Fisiologia e Controle de Artrópodes Vetores), Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil.
authors: Ricardo Augusto Dos
authors: RA
authors: Passos
authors: Health Surveillance Foundation of Amazonas State (Fundação de Vigilância em Saúde do Amazonas, FVS), Manaus, Brazil.
authors: Cristiano Fernandes da
authors: CF
authors: Costa
authors: Health Surveillance Foundation of Amazonas State (Fundação de Vigilância em Saúde do Amazonas, FVS), Manaus, Brazil.
authors: Megumi
authors: M
authors: Sadahiro
authors: Sérgio Arouca National School of Public Health (Escola Nacional de Saúde Pública Sérgio Arouca), FIOCRUZ, Rio de Janeiro, Brazil.|Institute of Social Medicine (Instituto de Medicina Social), Rio de Janeiro State University (Universidade do Estado do Rio de Janeiro, UERJ), Rio de Janeiro, Brazil.|PECTI-SAÚDE/Research Foundation of the State of Amazonas (Fundação de Amparo à Pesquisa do Estado do Amazonas, FAPEAM), Manaus, Brazil.
authors: José Ueleres
authors: JU
authors: Braga
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D019595:Severe Dengue / Q000453:epidemiology* / Q000401:mortality*; D012720:Severity of Illness Index; D055815:Young Adult