Factors associated with death from dengue and chikungunya virus infection during an epidemic period in Northeast Brazil: A retrospective cohort study

ABSTRACT Background: We investigated the time to death and factors associated with deaths from dengue and chikungunya during the first epidemic after the introduction of the chikungunya virus in Northeastern Brazil. Methods: This retrospective cohort study was conducted in Pernambuco between 2015 and 2018. Logistic regression was used to identify independent risk factors. The probability of survival among individuals with different arbovirus infections was estimated and the survival curves were compared using log-rank tests. Results: The lethality coefficients for dengue and chikungunya viruses were 0.08% and 0.35%, respectively. The chance of death due to chikungunya infection increased progressively from the age of 40 years. At 40-49 years, the odds ratio was 13.83 (95%CI, 1.80-106.41). At 50-59 years and 60 years or older, the odds ratio was 27.63 (95%CI, 3.70-206.48); and 78.72 (95%CI, 10.93-566.90), respectively. The probability of death associated with dengue virus infection increased from the age of 50 years. Among patients aged 50-59 years and 60 years or older, the odds ratio was 4.30 (95%CI, 1.80-10.30) and 8.97 (95%CI, 4.00-20.0), respectively. Independent factors associated death were headache and age of 50 years or older for dengue; and headache, nausea, back pain, intense arthralgia, age 0-9 years or 40 years and older, and male sex for chikungunya. The ratio between mortality rates revealed that the time to death from dengue was 2.1 times faster than that from chikungunya (95%CI, 1.57-2.72). Conclusions: The time to death was shorter in patients with dengue than in those with chikungunya disease. This study reinforces the need for faster and more effective decision-making in public health services to enhance patient outcomes and minimize mortality.

摘要

研究背景：本研究针对巴西东北部地区基孔肯雅病毒（chikungunya virus）传入后的首次流行期间，登革热（dengue）与基孔肯雅热患者的死亡时间及相关死亡危险因素展开调查。

方法：本研究为回顾性队列研究，于2015年至2018年间在伯南布哥州开展。采用Logistic回归分析识别独立危险因素；对不同虫媒病毒（arbovirus）感染者的生存概率进行估算，并通过对数秩检验（log-rank test）比较各组生存曲线。

结果：登革热病毒与基孔肯雅病毒的致死率分别为0.08%与0.35%。基孔肯雅热感染者的死亡风险自40岁起呈渐进式升高：40~49岁组的比值比（odds ratio）为13.83（95%置信区间[95%CI]：1.80~106.41）；50~59岁组与60岁及以上组的比值比分别为27.63（95%CI：3.70~206.48）与78.72（95%CI：10.93~566.90）。登革热病毒感染者的死亡风险自50岁起升高：50~59岁组与60岁及以上组的比值比分别为4.30（95%CI：1.80~10.30）与8.97（95%CI：4.00~20.0）。登革热患者的独立死亡危险因素为头痛与50岁及以上年龄；基孔肯雅热患者的独立死亡危险因素则包括头痛、恶心、背痛、剧烈关节痛、0~9岁或40岁及以上年龄，以及男性性别。死亡率比值分析显示，登革热患者的死亡时间较基孔肯雅热患者快2.1倍（95%CI：1.57~2.72）。

结论：登革热患者的死亡时间较基孔肯雅热患者更短。本研究进一步强调，公共卫生服务体系需加快决策速度、提升决策有效性，以改善患者预后并降低死亡率。