1 Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia.
2 Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Malaysia.
Vector Borne Zoonotic Dis. 2019 Jul;19(7):549-552. doi: 10.1089/vbz.2018.2379. Epub 2019 Jan 21.
There is an escalation of frequency and magnitude of dengue epidemics in Malaysia, with a concomitant increase in patient hospitalization. Prolonged hospitalization (PH) due to dengue virus (DENV) infections causes considerable socioeconomic burden. Early identification of patients needing PH could optimize resource consumption and reduce health care costs. This study aims to identify clinicopathological factors present on admission that are associated with PH among patients with DENV infections. This study was conducted in a tertiary referral hospital in Southern Malaysia. Relevant clinical and laboratory data upon admission were retrieved from medical records of 253 consecutive DENV nonstructural protein 1 (NS1) antigen and PCR-positive hospitalized patients. The DENV serotype present in each patient was determined. Patients were stratified based on duration of hospital stay (<4 vs. ≥4 days). Data were analyzed using IBM SPSS 25.0. Multivariate logistic regression was performed to examine the association between PH and admission parameters. Of 253 DENV hospitalized patients, 95 (37.5%) had PH (≥4 days). The mean duration of hospital stay was 3.43 ± 2.085 days (median = 3 days, interquartile range = 7 days). Diabetes mellitus (adjusted odds ratio [AOR] = 6.261, 95% confidence interval [CI] = 2.130-18.406, = 0.001), DENV-2 serotype (AOR = 2.581, 95% CI = 1.179-5.650, = 0.018), duration of fever ≤4 days (AOR = 2.423, 95% CI = 0.872-6.734, = 0.09), and a shorter preadmission fever duration (AOR = 0.679, 95% CI = 0.481-0.957, = 0.027) were independently associated with PH. However, PH was not found to be associated with symptoms on admission, secondary DENV infections or platelet count, hematocrit, or liver enzyme levels on admission. Early identification of these factors at presentation may alert clinicians to anticipate and recognize challenges in treating such patients, leading to more focused management plans that may shorten the duration of hospitalization.
马来西亚登革热疫情的频率和严重程度不断升级，住院患者也随之增加。登革病毒（DENV）感染导致的住院时间延长（PH）会给社会经济带来相当大的负担。早期识别需要 PH 的患者可以优化资源消耗并降低医疗保健成本。本研究旨在确定入院时存在的临床病理因素与 DENV 感染患者的 PH 相关。
这项研究在马来西亚南部的一家三级转诊医院进行。从 253 例连续的 DENV 非结构蛋白 1（NS1）抗原和 PCR 阳性住院患者的病历中检索到相关的临床和实验室数据。确定每位患者的 DENV 血清型。根据住院时间（<4 天与≥4 天）将患者分层。使用 IBM SPSS 25.0 分析数据。进行多变量逻辑回归以检查 PH 与入院参数之间的关联。
在 253 例 DENV 住院患者中，有 95 例（37.5%）发生 PH（≥4 天）。住院时间的平均持续时间为 3.43±2.085 天（中位数为 3 天，四分位距为 7 天）。糖尿病（调整后的优势比[OR] = 6.261，95%置信区间[CI] = 2.130-18.406， = 0.001）、DENV-2 血清型（OR = 2.581，95% CI = 1.179-5.650， = 0.018）、发热持续时间≤4 天（OR = 2.423，95% CI = 0.872-6.734， = 0.09）和较短的入院前发热时间（OR = 0.679，95% CI = 0.481-0.957， = 0.027）与 PH 独立相关。然而，PH 与入院时的症状、继发的 DENV 感染或血小板计数、血细胞比容或入院时的肝酶水平无关。
早期识别这些因素可能会提醒临床医生注意治疗此类患者所面临的挑战，并识别出这些挑战，从而制定更有针对性的管理计划，可能会缩短住院时间。
