Clinical characteristics, complications and outcomes of critically ill patients with Dengue in Brazil, 2012-2024: a nationwide, multicentre cohort study

TL;DR

This large multicentre study in Brazil analyzed critically ill dengue patients from 2012 to 2024, identifying key risk factors for complications and developing a machine learning tool for early prediction to improve patient management.

Contribution

The study provides the first comprehensive analysis of severe dengue cases in Brazilian ICUs over a decade and introduces a novel machine learning model for predicting complications.

Findings

10.1% of ICU dengue admissions developed complications

Age, chronic kidney disease, liver cirrhosis, low platelets, high leukocytes are key risk factors

The machine learning model accurately predicts complication risk

Abstract

Background. Dengue outbreaks are a major public health issue, with Brazil reporting 71% of global cases in 2024. Purpose. This study aims to describe the profile of severe dengue patients admitted to Brazilian Intensive Care units (ICUs) (2012-2024), assess trends over time, describe new onset complications while in ICU and determine the risk factors at admission to develop complications during ICU stay. Methods. We performed a prospective study of dengue patients from 253 ICUs across 56 hospitals. We used descriptive statistics to describe the dengue ICU population, logistic regression to identify risk factors for complications during the ICU stay, and a machine learning framework to predict the risk of evolving to complications. Visualisations were generated using ISARIC VERTEX. Results. Of 11,047 admissions, 1,117 admissions (10.1%) evolved to complications, including non-invasive (437 admissions) and invasive ventilation (166), vasopressor (364), blood transfusion (353) and renal replacement therapy (103). Age>80 (OR: 3.10, 95% CI: 2.02-4.92), chronic kidney disease (OR: 2.94, 2.22-3.89), liver cirrhosis (OR: 3.65, 1.82-7.04), low platelets (<50,000 cells/mm3; OR: OR: 2.25, 1.89-2.68), and high leukocytes (>7,000 cells/mm3; OR: 2.47, 2.02-3.03) were significant risk factors for complications. A machine learning tool for predicting complications was proposed, showing accurate discrimination and calibration. Conclusion. We described a large cohort of dengue patients admitted to ICUs and identified key risk factors for severe dengue complications, such as advanced age, presence of comorbidities, higher level of leukocytes and lower level of platelets. The proposed prediction tool can be used for early identification and targeted interventions to improve outcomes in dengue-endemic regions.