Elsevier

Journal of Critical Care

Volume 26, Issue 5, October 2011, Pages 449-452
Journal of Critical Care

Infectious Diseases
Clinical profile, intensive care unit course, and outcome of patients admitted in intensive care unit with dengue

https://doi.org/10.1016/j.jcrc.2011.05.007Get rights and content

Abstract

Purpose

The purpose of the study was to assess the clinical profile and course of dengue patients admitted to the intensive care unit (ICU) and to identify factors related to poor outcome.

Methods

All patients with dengue admitted to ICU over 2.5 years were included prospectively. Severity of illness was assessed by the Acute Physiology and Chronic Health Evaluation (APACHE) II score, and organ failure was determined by the Sequential Organ Failure Assessment score. Primary outcome measure was 28-day mortality. Logistic regression analysis was performed to identify factors predicting mortality.

Results

Data from 198 patients were analyzed. Mean age was 39.56 ± 17.1 years, and 61.1% were male. The commonest complaints were fever (96%) and rash (37.9%). Mean admission APACHE II and Sequential Organ Failure Assessment scores were 7.52 ± 7.8 and 4.52 ± 3.4, respectively. The commonest organ failure was coagulation (43.4%) followed by respiratory failure (13.1%). Vasopressors were required by 11.6%; and dialysis and mechanical ventilation were required by 7.6% and 9.1%, respectively. Mortality was 12 (6.1%); and on multivariate analysis, APACHE II score (odds ratio, 1.781; 95% confidence interval, 0.967-3.281; P = .048) could independently predict mortality.

Conclusions

Patients with dengue fever may require ICU admission for organ failure. Outcome is good if appropriate aggressive care and organ support are instituted. Admission APACHE II score may predict patients at higher risk of death.

Introduction

The World Health Organization (WHO) has identified dengue as the most rapidly spreading mosquito-borne viral disease in the world. It is estimated that 50 million dengue infections occur every year and that around 2.5 billion of the world's population lives in dengue-endemic countries [1]. Nearly 75% of the current global disease burden due to dengue is borne by the people living in the Southeast Asia region and Western Pacific region [1]. It is a major health issue in tropical and subtropical countries like India, and there have been annual dengue outbreaks in northern India especially in the postmonsoon season. Dengue fever may present with a wide spectrum of nonspecific clinical symptoms and may have unpredictable clinical course and outcome. It may present as dengue fever, dengue haemorrhagic fever, or dengue shock syndrome [2]. Although most patients recover after a self-limiting mild disease, a small proportion progress to severe dengue infection. Without appropriate therapy, dengue haemorrhagic fever may have a high fatality rate exceeding 20% [3]. But with early aggressive care, death rates can be reduced to less than 1%; and therefore, patients with severe disease may require intensive care [3]. However, there is a dearth of data regarding the epidemiology, clinical course, and outcome of patients with dengue fever admitted to intensive care units (ICUs). Hence, we undertook this study to assess the clinical profile and ICU course of dengue patients admitted to ICU and to identify the factors related to poor outcome.

Section snippets

Methods

A prospective observational cohort study was conducted in a medical ICU of a tertiary care center located in the metropolitan city of New Delhi, India. All consecutive adult patients with dengue infection admitted to ICU during the study period of July 2008 to December 2010 were included prospectively. Diagnosis of dengue infection was made on the basis of a positive nonstructural protein 1 antigen (enzyme-linked immunosorbent assay) result or the presence of serum immunoglobulin M antibodies

Results

Out of a total of 2052 admissions during the study period, data from 198 (9.65%) patients with dengue fever were analyzed. Mean age was 39.56 ± 17.1 years, and 121 (61.1%) were males (Table 1). The commonest presenting complaints were fever and rash, which were present in 190 (96%) and 75 (37.9%) patients, respectively. The commonest reason for ICU admission was severe thrombocytopenia (<20 000/mm3) with or without minor bleeding manifestations like petechiae, subconjunctival hemorrhages,

Discussion

Patients with dengue fever may present with organ failure, and these patients may often require ICU admission. The outcome of these patients is good if appropriate therapy and organ support are instituted. We observed a 28-day mortality of 6.1% in our patient cohort, and admission APACHE II score was found to be an independent factor predicting mortality.

Dengue generally affects the younger population, and other Indian studies have also reported a higher incidence in males [3], [7], [8]. It

Conclusions

Patients with dengue fever may require ICU admission for organ failure. Their outcome is good if appropriate aggressive care and organ support are instituted early. Severity of illness on ICU admission as assessed by APACHE II score may predict patients at higher risk of death.

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