{
  "abstract": "Objective: To identify factors associated with death among patients with severe dengue. Methods: We conducted a population-based retrospective cohort study including all laboratory-confirmed severe dengue cases reported in Espírito Santo, Brazil, between 2020 and 2024. Participants were classified according to the recorded outcome as fatal or non-fatal severe dengue cases. Results: Among 251 laboratory-confirmed severe dengue cases, 117 (46.6%) resulted in death. Fatal cases were significantly older than survivors. In the overall multivariable model, weak or undetectable pulse (RR, 1.74; 95% CI: 1.34-2.26), late-stage arterial hypotension (RR, 1.80; 95% CI: 1.34-2.42), progressive increase in hematocrit (RR, 1.43; 95% CI: 1.10-1.85), and altered level of consciousness (RR, 1.31; 95% CI: 1.02-1.67) were associated with a higher risk of death. Conversely, fever (RR, 0.72; 95% CI: 0.56-0.92) and a sudden drop in platelet count (RR, 0.76; 95% CI: 0.59-0.91) were associated with a lower risk of death. In the exploratory age-stratified analyzes, weak or undetectable pulse and late-stage arterial hypotension remained associated with a higher risk of death in both age groups, while progressive increase in hematocrit and sudden platelet drop were associated with death only among individuals aged <60 years, and fever was associated with a lower risk of death only among those aged ≥60 years. Conclusion: Mortality in severe dengue is predominantly associated with markers of advanced hemodynamic instability rather than early warning signs, particularly among older adults.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Public Health, Federal University of Espírito Santo, Vitória, Brazil; Post-Graduate Program in Infectious Diseases, Federal University of Espírito Santo, Vitória, Brazil",
    "Health Surveillance Sector, Health Department of Espírito Santo State, Vitória, Brazil",
    "Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore, Singapore",
    "Medical School, Federal University of Espírito Santo, Vitória, Brazil",
    "Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore, Singapore; Corresponding author: Kuan Rong Chan, Emerging Infectious Diseases Program, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore."
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Creuza Rachel Vicente"
    },
    {
      "affs": [
        1
      ],
      "name": "João Paulo Cola"
    },
    {
      "affs": [
        1
      ],
      "name": "Ana Paula Brioschi dos Santos"
    },
    {
      "affs": [
        1
      ],
      "name": "Theresa Cristina Cardoso"
    },
    {
      "affs": [
        0
      ],
      "name": "Crispim Cerutti Junior"
    },
    {
      "affs": [
        2
      ],
      "name": "Eng Eong Ooi"
    },
    {
      "affs": [
        3
      ],
      "name": "Stefano Gobbi"
    },
    {
      "affs": [
        3
      ],
      "name": "Julia Luch dos Santos"
    },
    {
      "affs": [
        0
      ],
      "name": "Angelica Espinosa Miranda"
    },
    {
      "affs": [
        4
      ],
      "name": "Kuan Rong Chan"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/51whdwy9hy2ze.bib",
  "cited_by": 0,
  "doi": "10.1016/j.ijid.2026.109084",
  "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S1201971226007198",
  "id": "51whdwy9hy2ze",
  "issns": [
    "1201-9712",
    "1878-3511"
  ],
  "landing_url": "https://doi.org/10.1016/j.ijid.2026.109084",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC109-216"
    ],
    [
      "openalex",
      "2739|Mosquito-borne diseases and control"
    ]
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  "openalex": "W7204591313",
  "pdf_url": "https://www.ijidonline.com/article/S1201-9712(26)00719-8/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-30",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/51whdwy9hy2ze.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:44:32Z",
      "native_id": "8255c33e73a94c63bf7b474dd3c1b615",
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      "url": "https://doi.org/10.1016/j.ijid.2026.109084"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Mosquito-borne diseases and control",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Factors associated with death in severe dengue: a retrospective cohort study in Espírito Santo, Brazil, 2020-2024",
  "title_text": "Factors associated with death in severe dengue: a retrospective cohort study in Espírito Santo, Brazil, 2020-2024",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:44:32Z",
  "url": "https://research.draconitic.com/paper/51whdwy9hy2ze",
  "venue": "International Journal of Infectious Diseases",
  "versions": []
}