Frontiers in Medicine (Jan 2025)

Risk factors associated with in-hospital mortality during yellow fever outbreak in Brazil

  • Max McClure,
  • Izabela Maurício de Rezende,
  • Leonardo Soares Pereira,
  • Maria Rita Teixeira Dutra,
  • Jordana Rodrigues Barbosa Fradico,
  • Rodrigo Macedo,
  • Marcelle Cardoso Marçal,
  • Lívia Soares Coelho Fonte Boa,
  • Alexandre Maurício Castro Bragato,
  • Flávio Augusto de Almeida Faria,
  • Livia Pamplona,
  • Rodrigo Fabiano do Carmo Said,
  • Carlos Eduardo Calzavara-Silva,
  • Dario Brock Ramalho,
  • Cintia Lopes de Brito Magalhães,
  • Pedro Augusto Alves,
  • Thaysa Drummond Palmeira Gama,
  • Gláucia Fernandes Cota,
  • Thomas P. Monath,
  • Olindo Assis Martins-Filho,
  • Marcelo Antônio Pascoal-Xavier,
  • Andrea Teixeira-Carvalho,
  • Betânia Paiva Drumond,
  • A. Desiree LaBeaud,
  • Yellow Fever Collaborative Group,
  • Argus Leão Araújo,
  • Barbara Lenoir,
  • Bruno Dala Vedova Gomes Beato,
  • Carolina Lins Rodrigues Vieira,
  • Daniel Vitor de Vasconcelos Santos,
  • Flavia Mansur Starling,
  • Gabriela Miana de Mattos Paixão,
  • Indiara Penido,
  • Izabela Aparecida Coelho,
  • Leandro Henrique Malta Cunha,
  • Letícia Menezes,
  • Livia Frota Rabelo,
  • Letícia Lemos Jardim,
  • Lívia Fulgêncio da Cunha Melo,
  • Lívia Zignago Moreira dos Santos,
  • Ludmila de Paula,
  • Luísa Lages de Abre Paladino,
  • Natalia Soares Albuquerque,
  • Simone Lopes Oliveira Lemos,
  • Tayrine Araújo

DOI
https://doi.org/10.3389/fmed.2025.1505005
Journal volume & issue
Vol. 12

Abstract

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ObjectiveTo characterize the clinical manifestations of yellow fever disease and identify risk factors for mortality.MethodsA retrospective study was conducted in the referral center for infectious diseases (Hospital Eduardo de Menezes-HEM) in Belo Horizonte, Minas Gerais, Brazil. Analysis included data from 283 patients with confirmed YF infection older than 13 years old who presented to HEM between January 2017 and June 2018. In-hospital mortality (hypothesis formulated after data collection), demographic factors and clinical and laboratory assessments were used.ResultsStudy patients were mainly men (87.6%), with a median age of 46.0 (IQR 36.5, 57.0). 131 (46.3%) patients were admitted to the ICU, and 62 (22.0%) used invasive mechanical ventilation for a median of 2 days (IQR 1, 3). The median (IQR) total length of stay (LOS) in the ICU was 6 days (IQR 4, 8). The in-hospital mortality rate was 24.0%. Age was significantly higher in fatal (median 49.5, IQR 41.0, 61.0]) than in non-fatal cases [46 (36, 55)] (p < 0.01). Male sex was associated with an increased risk of death (RR 4.66, 95% CI 1.19, 18.2; p < 0.01). Most common symptoms and signs on admission to HEM were fever (31.9%), myalgia (27.8%), jaundice (24.3%), headache (23.9%), abdominal pain (16.1%), vomiting (12.2%), weakness (10.4%), and arthralgias (10.0%). Initial viral load above the cutoff of 4.45 log10 copies/mL was significantly associated with death prior to discharge (OR 12.2; CI 2.83, 92.3). Five factors were significantly related to increased odds of death prior to discharge: log-transformed AST (OR 3.65; CI 2.02, 7.81; p < 0.001), log-transformed INR (OR 7.40; CI 1.31, 33.0; p = 0.010), log-transformed lactate (OR 4.57; CI 1.48, 17.1; p = 0.013), log-transformed WBC (OR 4.33; CI 1.19, 18.5; p = 0.034), and age (OR 1.06; CI 1.01, 1.12; p = 0.026).Conclusions and relevanceAST, INR, lactate, WBC, and age are statistically associated with death prior to discharge in YF patients. These clinical markers should be applied to improve patient screening and management during future YF epidemics.

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