Post-Graduation Program in Medical Sciences, Department of Internal Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil.
Post-Graduation Program in Medical Sciences, Department of Internal Medicine, Faculty of Medicine, Federal University of Alagoas, Maceió, Brazil.
Trop Med Int Health. 2022 Aug;27(8):656-668. doi: 10.1111/tmi.13797. Epub 2022 Jul 11.
To investigate risk factors for mortality in dengue.
We performed a systematic review and meta-analysis searching MEDLINE, Embase, SciELO, LILACS Bireme, and OpenGrey databases to identify eligible observational studies of patients with dengue, of both genders, aged 14 years or older, that analysed risk factors associated with mortality and reported adjusted risk measures with their respective confidence intervals (CIs). We estimated the pooled weighted mean difference and 95% CIs with a DerSimonian and Laird random-effects model. We assessed the methodological quality using the Newcastle-Ottawa Scale.
Of 1,170 citations reviewed, 18 papers, with a total of 25,851 patients, were included in the systematic review and 12 in the meta-analysis. Severe hepatitis (OR 29.222, 95% CI 3.876-220.314), dengue shock syndrome (OR 23.575, 95% CI 3.664-151.702), altered mental status (OR 3.76, 95% CI 1.67-8.42), diabetes mellitus (OR 3.698, 95% CI 1.196-11.433), and higher pulse rate (OR 1.039, 95% CI 1.011-1.067) are associated with mortality in patients with dengue. All studies included were classified as having a high quality.
Proper identification and management of these risk factors should be considered to improve patient outcomes and reduce the hidden burden of this neglected tropical disease. Future well-designed studies are needed to investigate the association of other clinical, radiological, and laboratorial findings with mortality in dengue, as well as to develop prognostic models based on the risk factors found in our study.
探讨登革热患者死亡的危险因素。
我们进行了系统评价和荟萃分析，检索了 MEDLINE、Embase、SciELO、LILACS Bireme 和 OpenGrey 数据库，以确定符合条件的登革热患者观察性研究，这些研究为 14 岁及以上的男女患者，分析了与死亡率相关的危险因素，并报告了调整后的风险测量值及其各自的置信区间 (CI)。我们使用 DerSimonian 和 Laird 随机效应模型估计了汇总加权平均差异和 95%CI。我们使用纽卡斯尔-渥太华量表评估了方法学质量。
在审查的 1170 篇引文中有 18 篇论文，共纳入了 25851 例患者，其中 12 篇论文纳入荟萃分析。严重肝炎（OR 29.222，95%CI 3.876-220.314）、登革热休克综合征（OR 23.575，95%CI 3.664-151.702）、精神状态改变（OR 3.76，95%CI 1.67-8.42）、糖尿病（OR 3.698，95%CI 1.196-11.433）和更高的脉搏率（OR 1.039，95%CI 1.011-1.067）与登革热患者的死亡率相关。所有纳入的研究均被归类为高质量。
应适当识别和管理这些危险因素，以改善患者预后，降低这种被忽视的热带病的潜在负担。需要进一步进行设计良好的研究，以调查其他临床、放射学和实验室发现与登革热死亡率的关系，并根据我们研究中发现的危险因素制定预后模型。
