Ruwanpathirana Pramith, Athukorala Harindri, Palliyaguru Thamalee, Weeratunga Praveen, Priyankara Dilshan
Professorial Unit in Medicine, National Hospital of Sri Lanka, Colombo, 00800, Sri Lanka.
Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
Trop Med Health. 2024 Nov 29;52(1):90. doi: 10.1186/s41182-024-00661-w.
The case fatality rate of untreated dengue is 20%; it can be reduced to less than 1% with optimal management. The leading causes of death in dengue patients are shock, bleeding, and acute liver injury. We describe the clinical features of patients who died of dengue and discuss the therapeutic challenges and pitfalls of complicated dengue.
This retrospective study was done in the intensive care unit (MICU) of the National Hospital of Sri Lanka over 30 months between 2021 and 2023. All patients who died of serologically confirmed dengue were incorporated.
Of the 1722 ICU admissions, 44 (2.6%) patients were treated for dengue-of them, 11 (25.0%) died. Two patients were excluded as their deaths were not directly linked to dengue. Six were females. The average age was 40.2 years. The leading causes of death included shock (n = 5), acute liver failure (n = 6), intracranial bleeding (n = 2), and pulmonary embolism (n = 1). Patient 1 had concomitant leakage and bleeding, which did not respond to fluids or blood products. He developed fluid overload and acute liver failure (ALF) and died of multiorgan dysfunction. Patients 2-5 were in shock for a prolonged period due to leakage ± bleeding. Patients 2-5 developed ALF and lactic acidosis followed by multiorgan dysfunction. Patient 8 developed acute hepatitis and ALF without preceding shock. The patient was treated with immunosuppressants for myasthenia gravis. Patients 6 and 7 experienced intracranial bleeding. Patient 9 died of pulmonary embolism after prolonged ventilation for dengue encephalitis.
Prolonged shock, fluid overload and acute liver failure were common causes of dengue related deaths, in our study. Fluid overload occurred when vigorous crystalloid resuscitation was continued in patients who were poorly responding. A prompt switch to colloids or blood could have prevented overload. Patients who were in shock for a prolonged period become unresponsive to fluid resuscitation. How to manage dengue in patients who take anti-inflammatory drugs, immunomodulators, or antiplatelets is not known. Balancing the bleeding risk of dengue in patients predisposed to bleeding or thrombosis is a challenge.
未治疗的登革热病死率为20%；通过优化管理可将其降至1%以下。登革热患者的主要死因是休克、出血和急性肝损伤。我们描述了死于登革热患者的临床特征，并讨论了复杂登革热的治疗挑战和陷阱。
这项回顾性研究于2021年至2023年的30个月内在斯里兰卡国立医院的重症监护病房（MICU）进行。纳入所有血清学确诊死于登革热的患者。
在1722例入住重症监护病房的患者中，44例（2.6%）因登革热接受治疗，其中11例（25.0%）死亡。2例患者因死亡与登革热无直接关联而被排除。6例为女性。平均年龄为40.2岁。主要死因包括休克（n = 5）、急性肝衰竭（n = 6）、颅内出血（n = 2）和肺栓塞（n = 1）。患者1同时出现渗漏和出血，对液体或血液制品无反应。他出现了液体超负荷和急性肝衰竭（ALF），死于多器官功能障碍。患者2 - 5因渗漏±出血而长期休克。患者2 - 5出现急性肝衰竭和乳酸酸中毒，随后出现多器官功能障碍。患者8在无前期休克的情况下发生急性肝炎和急性肝衰竭。该患者因重症肌无力接受免疫抑制剂治疗。患者6和7发生颅内出血。患者9因登革热脑炎长时间通气后死于肺栓塞。
在我们的研究中，长时间休克、液体超负荷和急性肝衰竭是登革热相关死亡的常见原因。对反应不佳的患者持续进行积极的晶体液复苏时会发生液体超负荷。及时改用胶体液或血液可能预防超负荷。长时间休克的患者对液体复苏无反应。如何治疗服用抗炎药、免疫调节剂或抗血小板药物的登革热患者尚不清楚。平衡易出血或易发生血栓的登革热患者的出血风险是一项挑战。
