Browsing by Author "Lee, Ing-Kit"

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Differences in Mortality and Clinical Manifestations of Dengue Hemorrhagic Fever in Taiwan in Different Years: A Comparison for Cases in 2014 and 2015 Epidemics
(2017-01-01)
Chang, Ko
;
Huang, Chung-Hao
;
Lee, Ing-Kit
;
Lu, Po-Liang
;
Lin, Chun-Yu
People in southern Taiwan experienced two major dengue outbreaks in 2014 and 2015. The mortality and clinical features were very different between these 2 years. Dengue virus serotype 1 (DENV-1) caused epidemic outbreak in 2014 and DENV-2 was predominant in 2015. The characteristics of dengue hemorrhagic fever (DHF) cases in the 2 years was analyzed. We conducted a retrospective chart review to analyze the clinical and laboratory features of 206 adult patients with DHF in southern Taiwan in 2014 and 2015. The mortality rate of DHF cases in 2015 was higher than that of cases in 2014 (38.7% versus 12.4%, P < 0.0001). Compared with cases in 2014, DHF cases in 2015 had more complications, such as gastrointestinal bleeding (78.5% versus 61.9%, P = 0.01), severe hepatitis (30.1% versus 8%, P < 0.0001), and myocarditis (14% versus 0.9%, P < 0.0001). Among the mortality cases, diabetes, chronic renal failure, proton-pump inhibitors using, platelet transfusion, and Charlson comorbidity index score (Charlson score) were also higher in 2015. Multivariate analysis for the mortality cases revealed that the risk factors were Charlson score (3) 5 (P = 0.02, odds ratio [OR] = 4.07, 95% confidence interval [CI] = 1.244-13.307), severe hepatitis (P < 0.0001, OR = 11.97, 95% CI = 3.831-37.396), and acute renal failure (P < 0.0001, OR = 98.76, 95% CI = 10.847-899.22). DHF cases in 2015 had higher mortality and more complications, such as gastrointestinal bleeding, severe hepatitis, and myocarditis, than in 2014 in southern Taiwan. In the 2-year DHF case series, Charlson score >= 5, severe hepatitis, and acute renal failure were independent significant variables for mortality.
Prognostic Factors in Adult Patients with Dengue: Developing Risk Scoring Models and Emphasizing Factors Associated with Death <= 7 Days after Illness Onset and <= 3 Days after Presentation
(2018-11-01)
Lee, Ing-Kit
;
Huang, Chung-Hao
;
Huang, Wen-Chi
;
Chen, Yi-Chun
;
Tsai, Ching-Yen
Dengue is a mosquito-borne viral disease that is a threat to global health. However, information relating to mortality <= 7 days after dengue onset and <= 3 days after presentation is limited. We retrospectively analyzed 1086 adults with dengue during a 12-year period. Three scoring models were established: model-1 (death <= 3 days after presentation), model-2 (death <= 7 days after illness onset), and model-3 (overall fatality). In total, 39 patients with fatal dengue were identified, of which 17 and 14 patients died <= 7 days after illness onset and <= 3 days after presentation, respectively. In model-1 (range: 0-4 points), gastrointestinal bleeding <= 72 h after presentation, thrombocytopenia (<50 x 10(9) cells/L) at presentation, and acute kidney injury after hospitalization, using a cutoff level of 2 points, exhibited good discrimination (area under the receiver curve (AUC): 0.975) between survivors and non-survivors. In model-2, the significant predictors were gastrointestinal bleeding <= 72 h after presentation, and hemoconcentration and leukocytosis after hospitalization. Model-2 (range: 0-4 points) showed an AUC of 0.974, with a cutoff value of 2 points. The independent factors in model-2 were the predictors of overall mortality (model-3), which include thrombocytopenia (<50 x 10(9) cells/L) at presentation. Using a cutoff value of 2 points, model-3 (range: 0-7 points) revealed an excellent discrimination between survivors and non-survivors (AUC: 0.963).