Clinical characteristics, complications and outcomes of critically ill patients with Dengue in Brazil, 2012-2024: A nationwide, multicenter cohort study
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Dengue outbreaks are a major public health issue, with Brazil reporting 71% of global cases in 2024. PURPOSE: This study aims to describe the profile of severe dengue patients admitted to Brazilian intensive care units (ICUs) (2012-2024), assess trends over time, describe new onset complications while in ICU, and determine the risk factors at admission to develop complications during ICU stay. METHODS: We performed a prospective study of dengue patients from 253 ICUs across 56 hospitals. We used descriptive statistics to describe the dengue ICU population, logistic regression to identify risk factors for complications during the ICU stay, and a machine learning framework to predict the risk of evolving to complications. Visualizations were generated using ISARIC VERTEX. RESULTS: Of 11,047 admissions, 1117 admissions (10.1%) evolved to complications, including non-invasive (437 admissions) and invasive ventilation (166), vasopressor (364), blood transfusion (353), and renal replacement therapy (103). Age ≥80 (odds ratio [OR]: 3.10, 95% confidence interval: 2.02-4.92), chronic kidney disease (OR: 2.94, 2.22-3.89), liver cirrhosis (OR: 3.65, 1.82-7.04), low platelets (<50,000 cells/mm³; OR: 2.25, 1.89-2.68), and high leukocytes (>7000 cells/mm³; OR: 2.47, 2.02-3.03) were significant risk factors for complications. A machine learning tool for predicting complications was proposed, showing accurate discrimination and calibration. CONCLUSION: We described a large cohort of dengue patients admitted to ICUs and identified key risk factors for severe dengue complications, such as advanced age, presence of comorbidities, higher level of leukocytes, and lower level of platelets. The proposed prediction tool can be used for early identification and targeted interventions to improve outcomes in dengue-endemic regions.
Institutions: Pontifícia Universidade Católica do Rio de Janeiro, Fundação Oswaldo Cruz, Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Institut de Recerca Sant Pau, Instituto do Coração - HCFMUSP, University of Oxford, International Severe Acute Respiratory and Emerging Infection Consortium, D’Or Institute for Research and Education, Universidade Nova de Lisboa
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,900
Funders: Bill and Melinda Gates Foundation, Wellcome Trust, Ministerio de Ciencia, Innovación y Universidades, Department for International Development, UK Government, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro, Ministerio de Ciencia e Innovación, Pontifícia Universidade Católica do Rio de Janeiro, Agencia Estatal de Investigación, European Social Fund
Awards: G105659125, G1175115578, G1809983139, G1840770272, ISARIC 3.0: Strengthening the global clinical research ecosystem for epidemic and pandemic prevention and preparedness, G2262748287, G2304316910, G2311368543, G2705022506, G2795154779, G294895050, G300979063, G3480869486, G3587002227, G3711163565, G4156530268, G4178081204, G425668148, G4320171638, ISARIC 3.0: Strengthening the global clinical research ecosystem for epidemic and pandemic prevention and preparedness, G469004258, G4728539003, G4926660250, G5047987291, G5080475149, University of Oxford - to strengthen clinical research readiness for epidemic disease response including by coordinating and strengthening the conduct of endemic disease ..., G593054264, G6218905885, G6668181273, G6698001430, G6714479959, G6743381775, G6759437759, G7019889415, G7084143925, G7127239378, G7393066450, G7739756423, G8260616629, G863151887, G8888022036, G914858229, G933372841
OpenAlex ID: W4413293334