• Chin-Ming Chen, Khee-Siang Chan, Wen-Liang Yu, Kuo-Chen Cheng, Hui-Chun Chao, Chiu-Yin Yeh, and Chih-Cheng Lai.
• Department of Recreation and Health-Care Management, Chia Nan University of Pharmacy and Science Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan Department of Medicine, Taipei Medical University, Taipei Department of Internal Medicine, Chi-Mei Medical Center Department of Safety Health and Environment, Chung Hwa University of Medical Technology Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
• Medicine (Baltimore). 2016 Aug 1; 95 (31): e4376.

AbstractOutcomes of adult patients with dengue infections requiring intensive care unit (ICU) admissions remain unclear. We assessed the clinical manifestations and prognostic factors of patients critically ill with severe dengue.This retrospective study was done in a tertiary referral hospital with 96 adult ICU beds. All of the patients with laboratory-confirmed severe dengue infections and admitted to the ICU were enrolled between July 31 and November 31, 2015, during the large outbreak period. The medical records of all the recruited patients were reviewed for the following information: age, gender, clinical manifestations, disease severity scores, underlying conditions, laboratory examinations, and outcomes. The primary endpoint was to find the predictors of ICU mortality.During the study period, 4787 patients with dengue infections required ICU admission. One hundred forty-three (2.99%) were critically ill (mean age: 69.7 years). Hypertension (n = 90, 62.9%) and diabetes mellitus (n = 70, 49.0%) were the 2 most common underlying diseases. Eighty critically ill patients (55.9%) had cobacterial infections, and 33 had cobacteremia. The hematologic system failed most often, followed by thoracic and cardiovascular systems. Fever was the most common presentation (n = 112; 78.3%), followed by anorexia (n = 47; 32.9%) and abdominal pain (n = 46; 32.2%). Overall, 33 patients died (mortality rate: 23.1%). Multivariate analysis showed that ICU mortality was significantly associated with lower Glasgow Coma Scale (GCS) scores, lower platelet counts before ICU discharge, and more organ failures.The number of severe dengue patients who require ICU admission remains high. The mortality rate was associated with lower GCS scores, lower platelet counts, and more organ failures. In addition, more than half of the critically ill dengue patients had comorbid bacterial infections.

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