Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Sci Rep. 2017 Jan 3;7:39872. doi: 10.1038/srep39872.
Progression to severe organ involvement due to dengue infection has been associated with severe dengue disease, intensive care treatment, and mortality. However, there is a lack of understanding of the impact of pre-existing comorbidities and other risk factors of severe organ involvement among dengue adults. The aim of this retrospective case-control study is to characterize and identify risk factors that predispose dengue adults at risk of progression with severe organ involvement. This study involved 174 dengue patients who had progressed with severe organ involvement and 865 dengue patients without severe organ involvement, matched by the year of presentation of the cases, who were admitted to Tan Tock Seng Hospital between year 2005 and 2008. Age group of 60 years or older, diabetes, cardiac disorders, asthma, and having two or more pre-existing comorbidities were independent risk factors of severe organ involvement. Abdominal pain, clinical fluid accumulation, and hematocrit rise and rapid platelet count drop at presentation were significantly associated with severe organ involvement. These risk factors, when validated in a larger study, will be useful for triage by clinicians for prompt monitoring and clinical management at first presentation, to minimize the risk of severe organ involvement and hence, disease severity.
由于登革热感染导致严重器官受累的进展与严重登革热、重症监护治疗和死亡率有关。然而，对于登革热成人中严重器官受累的预先存在的合并症和其他危险因素的影响，我们缺乏了解。本回顾性病例对照研究的目的是描述和确定使登革热成人易患严重器官受累进展的风险因素。该研究纳入了 174 例出现严重器官受累的登革热患者和 865 例未出现严重器官受累的登革热患者，这些患者是根据病例的就诊年份，于 2005 年至 2008 年期间在陈笃生医院住院的患者。60 岁或以上的年龄组、糖尿病、心脏疾病、哮喘和存在两种或两种以上预先存在的合并症是严重器官受累的独立危险因素。就诊时出现腹痛、临床体液积聚、血细胞比容升高和血小板计数迅速下降与严重器官受累显著相关。这些危险因素，如果在更大的研究中得到验证，将有助于临床医生在初次就诊时进行分诊，以便进行及时监测和临床管理，从而最大程度地降低严重器官受累的风险，从而降低疾病的严重程度。
