Paraná Victoria Cruz, Feitosa Caroline Alves, da Silva Greice Carolina Santos, Gois Luana Leandro, Santos Luciane Amorim
Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil.
Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil.
Trop Med Int Health. 2024 Mar;29(3):173-191. doi: 10.1111/tmi.13968. Epub 2024 Jan 23.
Severe dengue is a significant health problem in Latin America, with children being the most affected. Understanding risk factors for severe dengue is crucial for enhancing patient care. Therefore, this study aims to systematically review the literature to identify the risk factors associated with severe dengue in Latin America through systematic review and meta-analysis.
PubMed, SciELO, LILACS and EMBASE databases were used to search for eligible scientific articles for the review. The outcomes considered were symptoms of severe dengue, hospitalisation and death. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the quality of the studies. Data analysis was performed using STATA v 13.0 software. The degree of heterogeneity between studies was quantified using the I measure, and statistically significant results were defined as those with p values <0.05.
Of the 1876 articles screened, 47 articles were included in the systematic review and 45 articles were analysed through meta-analysis. Identified risk factors associated with severe dengue included secondary dengue infection, female sex, white or Caucasian ethnicity and specific signs and symptoms such as headache, myalgia and/or arthralgia, vomiting/nausea, abdominal pain or tenderness, diarrhoea, prostration, lethargy, fatigue or similar. For the death outcome, respiratory symptoms and age <18 years were identified as risk factors. On the other hand, in women, the diagnosis of positive tourniquet test, platelet count <100,000 per μL and symptoms of capillary fragility were associated with a lower probability of death. These data highlight the importance of early screening of patients, to identify possible haemorrhagic signs and reduce deaths from dengue. This study has limitations, including possible publication bias, heterogeneity of results and study design biases.
These findings are significant for shaping strategies, management approaches and identifying high-risk groups, which will help establish future guidelines.
重症登革热是拉丁美洲一个严重的健康问题，儿童受影响最为严重。了解重症登革热的危险因素对于改善患者护理至关重要。因此，本研究旨在通过系统评价和荟萃分析，系统回顾文献，以确定拉丁美洲与重症登革热相关的危险因素。
使用PubMed、SciELO、LILACS和EMBASE数据库检索符合条件的科学文章进行综述。所考虑的结果包括重症登革热的症状、住院和死亡。使用乔安娜·布里格斯研究所的批判性评价清单评估研究质量。使用STATA v 13.0软件进行数据分析。使用I统计量量化研究之间的异质性程度，具有统计学意义的结果定义为p值<0.05的结果。
在筛选的1876篇文章中，47篇文章纳入系统评价，45篇文章通过荟萃分析进行分析。确定的与重症登革热相关的危险因素包括登革热二次感染、女性、白种人或高加索人种以及特定的体征和症状，如头痛、肌痛和/或关节痛、呕吐/恶心、腹痛或压痛、腹泻、虚脱、嗜睡、疲劳或类似症状。对于死亡结果，呼吸道症状和年龄<18岁被确定为危险因素。另一方面，在女性中，束臂试验阳性诊断、血小板计数<每微升100,000以及毛细血管脆性症状与较低的死亡概率相关。这些数据突出了早期筛查患者以识别可能的出血体征并减少登革热死亡的重要性。本研究存在局限性，包括可能的发表偏倚、结果异质性和研究设计偏倚。
这些发现对于制定策略、管理方法和识别高危人群具有重要意义，这将有助于建立未来的指南。
