Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore.
Department of Infectious Diseases, National Centre for Infectious Diseases, Singapore City, Singapore.
J Med Virol. 2024 Jun;96(6):e29726. doi: 10.1002/jmv.29726.
There is a lack of evidence on the optimal administration of intravenous (IV) fluids in hospitalized adult dengue patients without compensated and hypotensive shock. This study utilized a well-established cohort of dengue patients to compare risks of progressing to severe dengue (SD) over time for patients who were administered IV fluid versus others who were not. We included adult patients (n = 4781) who were hospitalized for dengue infection from 2005 to 2008. Cases were patients who developed SD (n = 689) and controls were patients who did not up until discharge (n = 4092). We estimated the hazard ratios (HRs) and risk of SD over time between groups administered different volumes of IV fluids versus the no IV fluid comparison group using Cox models with time-dependent covariates. The doubly-robust estimation approach was used to control for the propensity of fluid administration given clinical characteristics of patients. Subgroup analyses by age, sex, and dengue warning signs before IV fluid administration were conducted. High (>2000 mL/day) IV fluids volume was associated with a higher risk of development of SD for those who had warning signs (HR: 1.77 [1.05-2.97], p: 0.0713) and for those below 55 years old (HR: 1.53 [1.04-2.25], p: 0.0713). Low (<1000 mL/day) IV fluids volume was protective against SD for patients without warning signs (HR: 0.757 [0.578-0.990], p: 0.0883), no lethargy (HR: 0.770 [0.600-0.998], p: 0.0847), and females (HR: 0.711 [0.516-0.980], p: 0.0804). Over the course of hospitalization, there were no significant differences in IV fluid administration and SD risk in most subgroups, except in those who experienced lethargy and were administered IV fluid volume or quantity. Administering high volumes of IV fluids may be associated with an increased risk of SD during hospitalization for adult dengue patients without shock. Judicious use of IV fluids as supportive therapy is warranted.
在没有代偿性和低血压性休克的住院成年登革热患者中，静脉（IV）输液的最佳给药方式缺乏证据。本研究利用一个成熟的登革热患者队列，比较了接受 IV 液体治疗与未接受 IV 液体治疗的患者随时间进展为重症登革热（SD）的风险。我们纳入了 2005 年至 2008 年因登革热感染住院的成年患者（n=4781）。病例为发生 SD（n=689）的患者，对照组为直至出院未发生 SD（n=4092）的患者。我们使用具有时间依赖性协变量的 Cox 模型，估计了接受不同 IV 液量治疗的患者与未接受 IV 液治疗的患者之间随时间推移的危险比（HR）和 SD 风险。使用双重稳健估计方法来控制患者临床特征下的液体给药倾向。进行了按年龄、性别和 IV 液给药前登革热预警信号进行的亚组分析。对于有预警信号的患者（HR：1.77[1.05-2.97]，p=0.0713）和年龄在 55 岁以下的患者（HR：1.53[1.04-2.25]，p=0.0713），高（>2000mL/天）IV 液量与 SD 发展风险较高相关。对于没有预警信号的患者（HR：0.757[0.578-0.990]，p=0.0883），无嗜睡（HR：0.770[0.600-0.998]，p=0.0847）和女性患者（HR：0.711[0.516-0.980]，p=0.0804），低（<1000mL/天）IV 液量具有预防 SD 的作用。在整个住院期间，除了那些出现嗜睡并接受 IV 液量或数量的患者外，大多数亚组中 IV 液给药和 SD 风险没有显著差异。对于没有休克的成年登革热患者，给予大量 IV 液可能会增加住院期间发生 SD 的风险。有必要谨慎使用 IV 液作为支持性治疗。
