Which factors predict death in children with severe dengue fever?

Disease severity, hyperlactatemia at admission, need for multiple vasoactive drugs, and positive fluid balance are significantly associated with death in children with severe dengue infection admitted to paediatric intensive care unit (PICU), reports a study.

The investigators enrolled all consecutive children with laboratory-confirmed severe dengue fever in this prospective observational study. They also recorded and analysed laboratory investigations and interventions conducted in PICU, as well as demographic data, disease severity, and organ dysfunction scores.

A total of 172 dengue patients were admitted to PICU over 42 months. Of these, 78 (45.3 percent) had severe disease and 20 (25.6 percent) died. Significant differences were noted in disease severity and organ dysfunction scores, transaminases, blood lactate level, and serum creatinine between survivors and nonsurvivors. Interventions in the first 24 hours of admission were provided to a significantly higher proportion of nonsurvivors.

No statistical difference was observed in platelet counts (p=0.22) and haematocrit (p=0.47) in the two cohorts, but nonsurvivors had a significantly high vasopressor—inotrope score (VIS; p<0.001) and positive fluid balance >10 percent (p=0.002).

In multivariate analysis, serum glutamic pyruvic transaminases (≥284 IU/L; odds ratio [OR], 1.002, 95 percent confidence interval [CI], 1.001–1.003), blood lactate level (≥2.73 mmol/L; OR, 2.08, 95 percent CI, 1.354–3.202), Pediatric Risk of Mortality score at 12 hours (≥14.5; OR, 1.35, 95 percent CI, 1.077–1.693), VIS (≥22.5; OR, 1.129, 95 percent CI, 1.059–1.204), and positive fluid balance >10 percent (OR, 22.937, 95 percent CI, 2.393–219.84) at 24 hours of admission independently predicted mortality.