A cohort study of hospitalized adult dengue patients with fatality in Taiwan: The elderly and febrile characteristics matter for prognosis

Abstract

Objective: To identify the febrile characteristics and clinical presentations associated with fatality in hospitalized adult patients with dengue virus (DENV) infections. Methods: A total of 289 adult hospitalized patients with laboratory-confirmed DENV infections were examined, of which 22 were fatal and 267 were non-fatal. A comparison of the clinical and laboratory characteristics was retrospectively conducted of the deceased and surviving individuals. Multivariate logistic regression and receiver operating characteristic curve analysis were performed to identify predictors of fatality. Results: Fatal patients exhibited significantly more comorbidities, particularly renal and cardiac comorbidities, and they were, in general, older than control individuals (P<0.000 1). The results of logistic regression analysis showed that febrile duration of less than four days before arriving in the Emergency Department (OR=5.34; 95% CI: 1.39–20.6), episode of hypotension in the Emergency Department (OR=6.95; 95% CI: 2.40–20.1), and comorbidity with congestive heart failure (OR=11.26; 95% CI: 2.31–54.79) were all significantly associated with inpatient fatality due to DENV infection. The ROC curve analysis indicated that the final prognostic model yielded an area under the curve of 0.87 (95% CI: 0.79–0.97) for fatality. Conclusions: The aforementioned clinical findings may help clinicians predict fatality among adult inpatients with DENV infection.

Keywords

• dengue; hospitalized patient; adult; fatality; febrile duration; hypotension