Risk factors for dengue with warning signs, in the emergency department of a Public Hospital. A case- control study
Abstract
Objective: To evaluate the risk factors for dengue with warning signs in patients seen in the emergency department of a Public Hospital located in Trujillo, Perú, during the period from January to October 2023. Materials and methods: A case- control study was conducted at the emergency department of the Hospital Distrital Jerusalén in Trujillo, Perú, between January and October 2023. In the data analysis, chi-square and Fisher tests were used to identify variables associated with warning signs of dengue (p<0.05); subsequently, multivariate logistic regression was performed to calculate the adjusted Odds ratio (ORa) with its respective 95% confidence intervals. Results: We included 92 cases of dengue with warning signs and 184 controls without warning signs. Age, education level, arterial hypertension, obesity and previous infection were significantly associated (p<0.05) to dengue with alarm signs. Logistic regression identified the following as risk factors for dengue with warning signs: arterial hypertension with an ORa of 8.27 (CI 95% 1.20-56.6), obesity with an ORa of 24.4 (CI 95% 7.58-78.9), previous infection with an ORa of 4.99 (CI 95% 1.75-14.2), age ≤ 14 years with an ORa of 5.88 (95% CI 2.08-19.61) and age ≥ 60 years with an ORa of 1.76 (95% CI 1.61-3.00). Conclusion: Arterial hypertension, obesity, previous dengue infection, age ≤ 14 years, and ≥ 60 years are risk factors for dengue with alarm signs.
Downloads
References
Harapan H, Michie A, Sasmono RT, Imrie A. Dengue: A Minireview. Viruses. 2020;12(8):829. doi: 10.3390/v12080829.
World Health Organization. Dengue and severe dengue [Internet]. Geneva: WHO; 2023 [citado 19 de mayo del 2022]. Disponible en: https://www.who.int/news-room/fact-sheets/detail/dengue-and- severe-dengue
Duany L, Águila N, Bravo E. Características clínicas y epidemiológicas de pacientes confirmados de dengue. MediSur. 2021;19(3):429-437.
Organización Panamericana de la Salud. Plataforma de información en salud para las Américas [Internet]. Washington, DC: OPS; 2023 [citado el 6 de Junio del 2023]. Disponible en: https://www3. paho.org/data/index.php/es/temas/indicadores-dengue/dengue- nacional/9-dengue-pais-ano.html?showall=1
Cabezas C, Fiestas V, García-Mendoza M, Palomino M, Mamani E, Donaires F. Dengue en el Perú: un cuarto de siglo después de su resurgimiento. Rev Perú Med Exp Salud Pública. 2015;32(1):146-5. doi: 10.17843/rpmesp.2015.321.1587.
Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud del Perú. Situación epidemiológica del dengue en el Perú a la SE 17 - 2023. Bol Epidemiol (Lima). 2023;32:413-415.
Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud del Perú. Situación del Dengue en el Perú hasta la SE 17 – 2023 [Internet]. Lima: Minsa; 2023 [citado el 6 jun 2023]. Disponible en: https://www.dge.gob.pe/epipublic/ uploads/dengue/dengue_202317_10_084859.pdf
adinegoro SR. The revised WHO dengue case classification: does the system need to be modified? Paediatr Int Child Health. 2012;32 Suppl 1(s1):33-8. doi: 10.1179/2046904712Z.00000000052.
Khanam A, Gutiérrez-Barbosa H, Lyke KE, Chua JV. Immune- Mediated Pathogenesis in Dengue Virus Infection. Viruses. 2022;14(11):2575. doi: 10.3390/v14112575.
Bhatt P, Sabeena SP, Varma M, Arunkumar G. Current Understanding of the Pathogenesis of Dengue Virus Infection. Curr Microbiol. 2021;78(1):17-32. doi: 10.1007/s00284-020-02284-w.
Rathore AP, Farouk FS, St John AL. Risk factors and biomarkers of severe dengue. Curr Opin Virol. 2020;43:1-8. doi: 10.1016/j. coviro.2020.06.008.
Pang J, Salim A, Lee VJ, Hibberd ML, Chia KS, Leo YS, et al. Diabetes with Hypertension as Risk Factors for Adult Dengue Hemorrhagic Fever in a Predominantly Dengue Serotype 2 Epidemic: A Case Control Study. PLoS Negl Trop Dis. 2012;6(5):e1641. doi: 10.1371/ journal.pntd.0001641.
PangJ,HsuJP,YeoTW,LeoYS,LyeDC.Diabetes,cardiacdisorders and asthma as risk factors for severe organ involvement among adult dengue patients: A matched case-control study. Sci Rep. 2017;7(1):39872. doi: 10.1038/srep39872.
Zulkipli MS, Dahlui M, Jamil N, Peramalah D, Wai HVC, Bulgiba A, et al. The association between obesity and dengue severity among pediatric patients: A systematic review and meta-analysis. PLoS Negl Trop Dis. 2018;12(2):e0006263. doi: 10.1371/journal. pntd.0006263.
Tan VPK, Ngim CF, Lee EZ, Ramadas A, Pong LY, Ng JI, et al. The association between obesity and dengue virus (DENV) infection in hospitalised patients. PLoS ONE. 2018;13(7):e0200698. doi: 10.1371/journal.pone.0200698.
Yang J, Mosabbir AA, Raheem E, Hu W, Hossain MS. Demographic characteristics, clinical symptoms, biochemical markers and probability of occurrence of severe dengue: A multicenter hospital-based study in Bangladesh. PLoS Negl Trop Dis. 2023;17(3):e0011161. doi: 10.1371/journal.pntd.0011161.
Martin BM, Evans AA, de Carvalho DS, Shimakura SE. Clinical outcomes of dengue virus infection in pregnant and non-pregnant women of reproductive age: a retrospective cohort study from 2016 to 2019 in Paraná, Brazil. BMC Infect Dis. 2022;22(1):5. doi: 10.1186/s12879-021-06985-w.
Suárez-OgnioL,ArrascoJ,CasapíaM,SihuinchaM,ÁvilaJ,SotoG, et al. Factores asociados a dengue grave durante la epidemia de dengue en la ciudad de Iquitos, 2010-2011. Rev Peru Epidemiol. 2011;15(1):17-23.
Pera A, Campos C, López N, Hassouneh F, Alonso C, Tarazona R, et al. Immunosenescence: Implications for response to infection and vaccination in older people. Maturitas. 2015;82(1):50-5. doi: 10.1016/j.maturitas.2015.05.004.
WichmannO,HongsiriwonS,BowonwatanuwongC,Chotivanich K, Sukthana Y, Pukrittayakamee S. Risk factors and clinical features associated with severe dengue infection in adults and children during the 2001 epidemic in Chonburi, Thailand. Trop Med Int Health. 2004;9(9):1022-9. doi: 10.1111/j.1365-3156.2004.01295.x.
VicenteCR,CeruttiJuniorC,FröschlG,RomanoCM,CabidelleAS, Herbinger KH. Influence of demographics on clinical outcome of dengue: a cross-sectional study of 6703 confirmed cases in Vitória, Espírito Santo State, Brazil. Epidemiol Infect. 2017;145(1):46-53. doi: 10.1017/S0950268816002004.
Dávila-Gonzálesz Jhoni Alberto, Guevara-Cruz Luis Antonio, Díaz- Vélez Cristian. Nivel de conocimientos de dengue, signos de alarma y prevención en distrito de reciente brote. Rev Haban Cienc Méd. 2021;20(2):e3133.
Chen CY, Chiu YY, Chen YC, Huang CH, Wang WH, Chen YH, et al. Obesity as a clinical predictor for severe manifestation of dengue: a systematic review and meta-analysis. BMC Infect Dis. 2023;23(1):502. doi: 10.1186/s12879-023-08481-9.
Lee MS, Hwang KP, Chen TC, Lu PL, Chen TP. Clinical characteristics of dengue and dengue hemorrhagic fever in a medical center of southern Taiwan during the 2002 epidemic. J Microbiol Immunol Infect. 2006;39(2):121-9.
Teixeira MG, Paixão ES, Costa MdCN, Cunha RV, Pamplona L, Dias JP, et al. Arterial Hypertension and Skin Allergy Are Risk Factors for Progression from Dengue to Dengue Hemorrhagic Fever: A Case Control Study. PLoS Negl Trop Dis. 2015;9(5):e0003812. doi: 10.1371/journal.pntd.0003812.
Singh R, Goyal S, Aggarwal N, Mehta S, Kumari P, Singh V, et al. Study on dengue severity in diabetic and non-diabetic population of tertiary care hospital by assessing inflammatory indicators. Ann Med Surg (Lond). 2022;82:104710. doi: 10.1016/j. amsu.2022.104710.
LattKZ,PoovorawanK,SriboonvorakulN,Pan-ngumW,Townamchai N, Muangnoicharoen S. Diabetes mellitus as a prognostic factor for dengue severity: Retrospective study from Hospital for Tropical Diseases, Bangkok. Clinical Infection in Practice. 2020;7-8:100028.
Figueiredo MA, Rodrigues LC, Barreto ML, Lima JW, Costa MC, Morato V, et al. Allergies and diabetes as risk factors for dengue hemorrhagic fever: results of a case control study. PLoS Negl Trop Dis. 2010;4(6):e699. doi: 10.1371/journal.pntd.0000699.
Tougma SA, Zoungrana/Yaméogo WN, Dahourou DL, Salou/ Kagoné IA, Compaoré TR, Kaboré A, et al. Dengue virus
infection and pregnancy outcomes during the 2017 outbreak in Ouagadougou, Burkina Faso: A retrospective cohort study. PLoS One. 2020;15(9):e0238431. doi: 10.1371/journal.pone.0238431.
Basurko C, Everhard S, Matheus S, Restrepo M, Hildéral H, Lambert V, et al. A prospective matched study on symptomatic dengue in pregnancy. PLoS One. 2018;13(10):e0202005. doi: 10.1371/journal. pone.0202005.
Hanf M, Friedman E, Basurko C, Roger A, Bruncher P, Dussart P, et al. Dengue epidemics and adverse obstetrical outcomes in French Guiana: a semi-ecological study. Trop Med Int Health. 2014;19(2):153-8. doi: 10.1111/tmi.12240.
YuanK,ChenY,ZhongM,LinY,LiuL.Riskandpredictivefactors for severe dengue infection: A systematic review and meta- analysis. PLoS One. 2022;17(4):e0267186. doi: 10.1371/journal. pone.0267186.
Khurram M, Qayyum W, Hassan SJ, Mumtaz S, Bushra HT, Umar M. Dengue hemorrhagic fever: comparison of patients with primary and secondary infections. J Infect Public Health. 2014;7(6):489-95. doi: 10.1016/j.jiph.2014.05.005.
GuzmanMG,AlvarezM,HalsteadSB.Secondaryinfectionasarisk factor for dengue hemorrhagic fever/dengue shock syndrome: an historical perspective and role of antibody-dependent enhancement of infection. Arch Virol. 2013;158(7):1445-59. doi: 10.1007/s00705-013-1645-3.
Halstead SB. Dengue hemorrhagic fever: two infections and antibody dependent enhancement, a brief history and personal memoir. Rev Cubana Med Trop. 2002;54(3):171-9.
1.png)
.png){kind=logo}
