Risk Factors of Severity of Dengue Fever in Children in the Emergency Department from Two Epidemic Periods (2012 - 2013 and 2017 - 2019) in Paraguay

Background: Dengue shock syndrome (DSS) is a major public health problem with high morbidity and mortality. Early diagnosis of shock and adequate replacement of plasma loss may decrease severity. Therefore, DSS risk factor identification is crucial for early detection and proper management of shock.

Methods: Medical records of 213 patients with dengue fever admitted at two pediatric reference centers of Paraguay were evaluated. Clinical and demographic data were collected in a pre-designed form such as duration of fever, signs and symptoms (shock , body pain, gastrointestinal symptoms, bleeding, abdominal pain, hypotension, among others) and laboratory data [hematocrit, platelet count, fibrinogen, activated partial thromboplastin time (APTT), liver transaminases (ALT/AST)]. Data related to patient evolution (admission to the ICU, mechanical ventilation (MV) and mortality) and complications (organ involvement, ascites and pleural effusion) were also recorded. Risk factors of severity of dengue fever were determined by chi square at a significance level of 0.05.

Results: Of the 290 children, 20 (9.4%) presented decompensated DSS; mortality rate was 2.3%, PICU (9.4%) and MV (2.8%). Risk factors for death were: decompensated DSS (RR: 38.6; CI95%: 4.5-328.9); bleeding (RR: 1.06; CI95%: 0.99-1.13), ascites (RR: 16.2; CI95%: 2,9-91,0), pleural effusion, alterations of APTT and fibrinogen (RR: 38.6; CI95%: 4.5-328.9).

Conclusion: Patients with dengue fever presenting these risk factors should be closely observed for early signs of shock with hypotension, as prompt and adequate fluid replacement and eventually inotropic therapy in order to improve clinical outcomes.