Programa de Pós-graduação em Saúde Coletiva, Universidade Federal do Ceará, Fortaleza, CE, Brasil.
Faculdade de Medicina, Centro Universitário Christus, Fortaleza, CE, Brasil.
PLoS One. 2022 Apr 7;17(4):e0260939. doi: 10.1371/journal.pone.0260939. eCollection 2022.
In 2016/2017 we had a major epidemic of chikungunya (CHIK) in Brazil, with many deaths. We evaluated to factors associated with deaths from CHIK that occurred in the city of Fortaleza, Brazil.
A matched case-control study was conducted (1:2), by sex, age (± 5 years) and neighborhood. Cases were CHIK deaths that occurred between January 1 and December 31, 2017, in Fortaleza, Brazil, and which were laboratory confirmed. Controls were laboratory confirmed CHIK patients occurring in the same neighborhood and in the same period, but which did not progress to death.
82 cases of CHIK and 164 controls were included. Considering the clinical history, significant associations were found between other chronic heart diseases (OR 3.8; CI: 1.53-9.26) and chronic kidney disease (OR 12.77; CI: 2.75-59.4). In the multivariate analysis of the variables related to signs and symptoms, fever (OR: 19.23 CI: 1.73-213.78), abdominal pain (OR: 3; 74 CI: 1.06-13.16), apathy (OR: 11.62 CI: 2.95-45.82) and dyspnea (OR: 50.61; CI: 12.37-207.18) were identified with greater likelihood of death from CHIK. It also stood out that altered blood glucose was associated with cases with a worse prognosis (OR: 13.5; CI: 1.3-135.0). Among the laboratory findings, only lymphocytes and albumin were not associated with greater likelihood of death.
The factors related with deaths were chronic kidney disease and previous heart disease, presence of fever, abdominal pain, apathy, dyspnea and arthritis and laboratory findings such as leukocytosis, leukopenia, thrombocytopenia, neutropenia and lymphopenia.
2016/2017 年，巴西爆发了大规模基孔肯雅热（CHIK）疫情，导致许多人死亡。我们评估了巴西福塔莱萨市 CHIK 死亡病例的相关因素。
采用病例对照研究（1:2），按性别、年龄（±5 岁）和社区进行匹配。病例为 2017 年 1 月 1 日至 12 月 31 日期间在巴西福塔莱萨市实验室确诊的 CHIK 死亡病例。对照为同一社区、同一时期实验室确诊的 CHIK 患者，但未发展为死亡。
共纳入 82 例 CHIK 病例和 164 例对照。考虑临床病史，发现其他慢性心脏病（OR 3.8；95%CI：1.53-9.26）和慢性肾脏病（OR 12.77；95%CI：2.75-59.4）与 CHIK 死亡显著相关。在与体征和症状相关的变量的多变量分析中，发热（OR：19.23；95%CI：1.73-213.78）、腹痛（OR：3；95%CI：1.06-13.16）、淡漠（OR：11.62；95%CI：2.95-45.82）和呼吸困难（OR：50.61；95%CI：12.37-207.18）与 CHIK 死亡的可能性更大。值得注意的是，血糖改变与预后较差的病例相关（OR：13.5；95%CI：1.3-135.0）。在实验室发现中，只有淋巴细胞和白蛋白与死亡可能性增加无关。
与死亡相关的因素是慢性肾脏病和既往心脏病、发热、腹痛、淡漠、呼吸困难和关节炎以及实验室发现如白细胞增多、白细胞减少、血小板减少、中性粒细胞减少和淋巴细胞减少。
