老年人登革热的挑战：不典型表现和重症登革热及医院获得性感染的风险[已更正]。
Challenges in dengue fever in the elderly: atypical presentation and risk of severe dengue and hospital-acquired infection [corrected].
机构信息
Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Singapore.
Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Singapore.
出版信息
PLoS Negl Trop Dis. 2014 Apr 3;8(4):e2777. doi: 10.1371/journal.pntd.0002777. eCollection 2014 Apr.
BACKGROUND/METHODS: To better understand dengue fever in the elderly, we compared clinical features, World Health Organization (WHO) dengue classification and outcomes between adult (<60) and elderly (≥60) dengue patients. We explored the impact of co-morbidity and hospital-acquired infection (HAI) on clinical outcomes in the elderly. All patients managed at the Communicable Disease Centre, Singapore, between 2005 and 2008 with positive dengue polymerase chain reaction (PCR) or who fulfilled WHO 1997 or 2009 probable dengue criteria with positive dengue IgM were included.
RESULTS
Of the 6989 cases, 295 (4.4%) were elderly. PCR was positive in 29%. The elderly suffered more severe disease with more dengue haemorrhagic fever (DHF) (29.2% vs. 21.4%) and severe dengue (SD) (20.3% vs. 14.6%) (p<0.05). Classic dengue symptoms were more common in the adult group. The elderly were less likely to fulfill WHO 1997 (93.6% vs. 96.4%) (p = 0.014), but not WHO 2009 probable dengue (75.3% vs. 71.5%). Time to dengue diagnosis was similar. There was no significant difference in the frequency of warning signs between the two groups, but the elderly were more likely to have hepatomegaly (p = 0.006) and malaise/lethargy (p = 0.033) while the adults had significantly more mucosal bleeding (p<0.001). Intensive care admission occurred in 15 and death in three, with no age difference. Notably, the elderly stayed in hospital longer (median 5 vs. 4 days), and suffered more pneumonia (3.8% vs. 0.7%) and urinary infection (1.9% vs. 0.3%) (p = 0.003). Predictors of excess length of stay were age (adjusted odds ratio [aOR] 2.01, 95% confidence interval [CI] 1.37-2.88), critical illness (aOR 5.13, 95%CI 2.59-9.75), HAI (aOR 12.06, 95%CI 7.39-19.9), Charlson score (aOR 6.9, 95%CI 2.02-22.56) and severe dengue (DHF/dengue shock syndrome/SD) (aOR 2.24, 95%CI 1.83-2.74).
CONCLUSION
Elderly dengue patients present atypically and are at higher risk of DHF, SD and HAI. Aside from dengue severity, age, co-morbidity and HAI were associated with longer hospital stay.
背景/方法：为了更好地了解老年人登革热，我们比较了成人（<60 岁）和老年（≥60 岁）登革热患者的临床特征、世界卫生组织（WHO）登革热分类和结局。我们探讨了合并症和医院获得性感染（HAI）对老年人临床结局的影响。所有患者均在新加坡传染病中心管理，2005 年至 2008 年间，登革热聚合酶链反应（PCR）阳性或符合 WHO1997 年或 2009 年可能登革热标准且登革热 IgM 阳性的患者均纳入研究。
结果
在 6989 例患者中，295 例（4.4%）为老年人。PCR 阳性率为 29%。老年人疾病更严重，登革出血热（DHF）（29.2% vs. 21.4%）和严重登革热（SD）（20.3% vs. 14.6%）（p<0.05）的比例更高。成人组更常见典型登革热症状。老年人符合 WHO1997 年标准的可能性较低（93.6% vs. 96.4%）（p=0.014），但符合 WHO2009 年可能登革热标准的可能性相似（75.3% vs. 71.5%）。登革热诊断时间相似。两组之间预警症状的频率无显著差异，但老年人肝肿大（p=0.006）和不适/嗜睡（p=0.033）的可能性更高，而成年人黏膜出血的发生率显著更高（p<0.001）。15 例患者入住重症监护病房，3 例患者死亡，两组间无年龄差异。值得注意的是，老年人住院时间更长（中位数 5 天 vs. 4 天），且更易发生肺炎（3.8% vs. 0.7%）和尿路感染（1.9% vs. 0.3%）（p=0.003）。住院时间延长的预测因素包括年龄（调整优势比[aOR] 2.01，95%置信区间[CI] 1.37-2.88）、重病（aOR 5.13，95%CI 2.59-9.75）、HAI（aOR 12.06，95%CI 7.39-19.9）、Charlson 评分（aOR 6.9，95%CI 2.02-22.56）和严重登革热（DHF/登革热休克综合征/SD）（aOR 2.24，95%CI 1.83-2.74）。
结论
老年登革热患者临床表现不典型，且发生 DHF、SD 和 HAI 的风险更高。除了登革热严重程度外，年龄、合并症和 HAI 与住院时间延长有关。
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