02784nas a2200313   4500000000100000008004100001653003000042653001700072653001300089653001700102653002100119100001200140700001200152700001000164700001100174700001100185700001500196700002100211700001100232700001300243700001100256700001300267245009100280856008900371300001300460490000700473520197600480022001402456       2016                            d10aSocio-demographic factors10aRisk Factors10aMalaysia10aDengue virus10aClinical aspects1 aLiew SM1 aKhoo EM1 aHo BK1 aLee YK1 aOmar M1 aAyadurai V1 aMohamed Yusoff F1 aSuli Z1 aMudin RN1 aGoh PP1 aChinna K00aDengue in Malaysia: Factors associated with dengue mortality from a national registry.  uhttp://journals.plos.org/plosone/article/asset?id=10.1371%2Fjournal.pone.0157631.PDF  ae01576310 v113 a<p><strong>BACKGROUND: </strong>The increasing incidence and geographical distribution of dengue has had significant impact on global healthcare services and resources. This study aimed to determine the factors associated with dengue-related mortality in a cohort of Malaysian patients.</p>

<p><strong>METHODS: </strong>This was a retrospective cohort study of patients in the Malaysian National Dengue Registry of 2013. The outcome measure was dengue-related mortality. Associations between sociodemographic and clinical variables with the outcome were analysed using multivariate analysis.</p>

<p><strong>RESULTS: </strong>There were 43 347 cases of which 13081 were serologically confirmed. The mean age was 30.0 years (SD 15.7); 60.2% were male. The incidence of dengue increased towards the later part of the calendar year. There were 92 probable dengue mortalities, of which 41 were serologically confirmed. Multivariate analysis in those with positive serology showed that increasing age (OR 1.03; CI:1.01-1.05), persistent vomiting (OR 13.34; CI: 1.92-92.95), bleeding (OR 5.84; CI 2.17-15.70) and severe plasma leakage (OR 66.68; CI: 9.13-487.23) were associated with mortality. Factors associated with probable dengue mortality were increasing age (OR 1.04; CI:1.03-1.06), female gender (OR 1.53; CI:1.01-2.33), nausea and/or vomiting (OR 1.80; CI:1.17-2.77), bleeding (OR 3.01; CI:1.29-7.04), lethargy and/or restlessness (OR 5.97; CI:2.26-15.78), severe plasma leakage (OR 14.72; CI:1.54-140.70), and shock (OR 1805.37; CI:125.44-25982.98), in the overall study population.</p>

<p><strong>CONCLUSIONS: </strong>Older persons and those with persistent vomiting, bleeding or severe plasma leakage, which were associated with mortality, at notification should be monitored closely and referred early if indicated. Doctors and primary care practitioners need to detect patients with dengue early before they develop these severe signs and symptoms.</p>
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