State Health Department of the Federal District, University Hospital, University of Brasília, Pan American Health Organization, Brasília, Brazil.
Am J Trop Med Hyg. 2013 Apr;88(4):670-6. doi: 10.4269/ajtmh.11-0774. Epub 2013 Feb 11.
Although increases in severity of mortality from dengue infection have been observed in Brazil, their determinants are not fully known. A case-control study was conducted by using the National Notifiable Diseases Surveillance System, including patients with severe dengue during 2000-2005. Cases were defined as patients that died and controls were those who survived. Hierarchical multivariate logistic regression was performed. During the study period, there were 12,321 severe cases of dengue and 1,062 deaths. Factors independently associated with death included age ≥ 50 years (odds ratio [OR] = 2.29, 95% confidence interval [CI] = 1.59-3.29), < 4 years of schooling (OR = 1.83, 95% CI = 1.47-2.28), a rural area (OR =2.84, 95% CI = 2.19-3.69), hospitalization (OR = 1.42, 95% CI = 1.17-1.73), and a high hematocrit (OR = 2.46, 95% CI = 1.85-3.28). Factors associated with a lower chance of dying were female sex (OR = 0.76, 95% CI = 0.67-0.87), history of previous dengue (OR = 0.78, 95% CI = 0.62-0.99), positive tourniquet test result (OR = 0.47, 95% CI = 0.33-0.66), laboratory diagnosis of dengue (OR = 0.75, 95% CI = 0.61-0.92), and a platelet count of 50,000-100,000 cells/mm(3) (OR = 0.56, 95% CI = 0.36-0.87). The risk profile identified in this study should serve to direct public health interventions to minimize deaths.
尽管巴西已观察到登革热感染死亡率的严重程度有所增加，但该病的决定因素尚未完全明确。采用国家法定传染病监测系统，对 2000 年至 2005 年间重症登革热患者进行了病例对照研究。病例定义为死亡患者，对照为存活患者。采用分层多变量逻辑回归分析。研究期间共发现 12321 例重症登革热病例和 1062 例死亡病例。与死亡独立相关的因素包括年龄≥50 岁（比值比[OR] = 2.29，95%置信区间[CI] = 1.59-3.29）、受教育程度<4 年（OR = 1.83，95%CI = 1.47-2.28）、农村地区（OR = 2.84，95%CI = 2.19-3.69）、住院（OR = 1.42，95%CI = 1.17-1.73）和高血细胞比容（OR = 2.46，95%CI = 1.85-3.28）。降低死亡风险的因素包括女性（OR = 0.76，95%CI = 0.67-0.87）、有既往登革热病史（OR = 0.78，95%CI = 0.62-0.99）、束臂试验阳性（OR = 0.47，95%CI = 0.33-0.66）、实验室诊断为登革热（OR = 0.75，95%CI = 0.61-0.92）和血小板计数为 50,000-100,000 个细胞/mm(3)（OR = 0.56，95%CI = 0.36-0.87）。本研究确定的风险特征应有助于指导公共卫生干预措施，以尽量减少死亡。
