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

Abstract

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).