Factors associated with death in severe dengue: a retrospective cohort study in Espírito Santo, Brazil, 2020-2024
5 affiliations
- 1Department of Public Health, Federal University of Espírito Santo, Vitória, Brazil; Post-Graduate Program in Infectious Diseases, Federal University of Espírito Santo, Vitória, Brazil
- 2Health Surveillance Sector, Health Department of Espírito Santo State, Vitória, Brazil
- 3Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore, Singapore
- 4Medical School, Federal University of Espírito Santo, Vitória, Brazil
- 5Emerging 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.
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.
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BibTeX
@article{vicente2026factors,
title = {{Factors associated with death in severe dengue: a retrospective cohort study in Espírito Santo, Brazil, 2020-2024}},
author = {Creuza Rachel Vicente and João Paulo Cola and Ana Paula Brioschi dos Santos and Theresa Cristina Cardoso and Crispim Cerutti Junior and Eng Eong Ooi and Stefano Gobbi and Julia Luch dos Santos and Angelica Espinosa Miranda and Kuan Rong Chan},
journal = {International Journal of Infectious Diseases},
year = {2026},
month = oct,
doi = {10.1016/j.ijid.2026.109084},
url = {https://doi.org/10.1016/j.ijid.2026.109084},
note = {CC BY},
}
RIS
TY - JOUR
TI - Factors associated with death in severe dengue: a retrospective cohort study in Espírito Santo, Brazil, 2020-2024
AU - Creuza Rachel Vicente
AU - João Paulo Cola
AU - Ana Paula Brioschi dos Santos
AU - Theresa Cristina Cardoso
AU - Crispim Cerutti Junior
AU - Eng Eong Ooi
AU - Stefano Gobbi
AU - Julia Luch dos Santos
AU - Angelica Espinosa Miranda
AU - Kuan Rong Chan
PY - 2026
DA - 2026/10/30
JO - International Journal of Infectious Diseases
DO - 10.1016/j.ijid.2026.109084
UR - https://doi.org/10.1016/j.ijid.2026.109084
AB - 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.
SN - 1201-9712
SN - 1878-3511
ER -