In-Hospital Mortality in Mechanically Ventilated Children With Severe Dengue Fever: Explanatory Factors in a Single-Center Retrospective Cohort From Vietnam, 2013-2022.

OBJECTIVES

Severe dengue fever complicated by critical respiratory failure requiring mechanical ventilation (MV) contributes to high mortality rates among PICU-admitted patients. This study aimed to identify key explanatory variables of fatality in mechanically ventilated children with severe dengue.

DESIGN

Retrospective cohort, from 2013 to 2022.

SETTING

PICU of the tertiary Children's Hospital No. 2, in Vietnam.

PATIENTS

Two hundred children with severe dengue fever who received MV.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We analyzed clinical and laboratory data during the PICU stay. The primary outcome was 28-day in-hospital mortality. Backward stepwise multivariable logistic regression was performed to identify the explanatory variables associated with dengue-associated mortality at the initiation of MV. The model performance was assessed using C-statistics, calibration plot, and Brier score. The patients had a median age of 7 years (interquartile range, 4-9). Overall, 47 (24%) of 200 patients died in the hospital. Five factors were associated with greater odds of mortality: severe transaminitis (aspartate aminotransferase or alanine aminotransferase ≥ 1000 IU/L), high blood lactate levels, vasoactive-inotropic score (> 30), dengue encephalitis, and peak inspiratory pressure on MV. The model performance in training (test) sets was a C-statistic of 0.86 (0.84), a good calibration slope 1.0 (0.89), and a Brier score of 0.08.

CONCLUSIONS

In our center, from 2013 to 2022, MV-experienced patients with severe dengue had a high mortality rate. The main explanatory factors associated with greater odds of death (related to critical liver injury, shock, and MV) may inform future practice in such critically ill patients.