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Fatores associados ao dengue grave em crianças: estudo caso-controle em três hospitais pediátricos no município do Rio de Janeiro
| Content Provider | Semantic Scholar |
|---|---|
| Author | Wakimoto, Mayumi Duarte |
| Copyright Year | 2011 |
| Abstract | The study aimed to evaluate demographic, clinical and laboratorial factors associated to severe dengue in hospitalized children from three pediatric hospitals in Rio de Janeiro. Initially, a systematic review about clinical and laboratorial aspects associated to severe dengue was developed. The parameters which revealed strong association to severe cases were: lethargy, hepatomegaly, hematocrit level >50%, hemoconcentration >22% and bleeding. Those are warning signs according to World Health Organization (WHO). The following signs were also associated to dengue shock syndrome (DSS): virus type, secondary dengue infection and obesity. The results presented important heterogeneity. Further studies with adequate designs and methods for the investigation of predictive factors of severity in children, allowing comparison of the clinical and epidemiological pattern in different populations, are needed. To evaluate demographic, clinical and laboratorial factors associated to severe dengue in children in Rio de Janeiro, a case-control study was conducted in three reference hospitals. A total of 308 children from 0 to 18 years old admitted with dengue diagnosis was evaluated: 89 cases of shock, according to the definition of the study, and 219 controls. The mean age was 7,9 years old for cases and 9,1 years old among controls. There was no significant association of sex and race with severe dengue. All the warning signs presented significant association with severe dengue in univariate analysis: restlessness (OR:9,1;CI95%3,8–21,6 p=0,000), lethargy (OR:17,4; CI95%8,3– 36,8 p=0,000), persistent vomiting (OR:2,3; CI95%1,2– 4,4 p=0,01), lipothymia (OR:3,4 CI95%1,6 –7,0 p=0,001), oliguria (OR:12,0; CI95%5,9 – 24,2 p=0,000), hypotermia (OR:26,58 CI95%5,9–118,8 p=0,000), respiratory distress (OR:10,3 IC95%5,5–19,2 p=0,000), intense abdominal pain (OR:3,86; IC95%2,2–6,8 p=0,000), tender hepatomegaly (OR:2,69; CI95% 1,5–4,7 p=0,001), severe hemorrhage (OR:3,9; CI95% 2,1–7,2 p=0,000), sudden hematocrit raise (OR:2,2; CI95%1, –4,0 p=0,006), rapid platelet count decrease (OR:5,0; CI95%1,2– 22,0 p=0,001). The factors which remained in the final logistic regression model associated to shock were: lethargy (OR:11,1; CI95%4,4-28,3), oliguria (OR:1,2; CI95%4,5-27,6) and dyspnea (OR:9,2; IC95%.4,2-20,3). The study stressed the importance of monitoring clinical signs, confirmed the relevance of the warning signs and defined indicators of clinical evolution to shock in hospitalized children with dengue. |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://www.arca.fiocruz.br/bitstream/icict/14460/3/246.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
