Most common comorbidities (N = 891).

BackgroundIn Vietnam, dengue has been endemic for many years, with most cases reported in children. Recently, epidemiological data show an increasing frequency in adults, especially for severe dengue. An unprecedented post-COVID-19 surge resulted in an exceptionally high number of hospitalized dengue cases. We aim to describe the clinical phenotypes and outcomes in Vietnamese adults with severe dengue during the 2022 outbreak and explore host-related factors associated with disease variability and severity, through a retrospective study.FindingsA total of 891 cases were included, with mean age 29 ± 10 years. 284/891 (31.9%) patients had a BMI ≥ 25 kg/m2, and 240/891 (26.9%) had comorbidities. The predominant severe clinical phenotype was dengue shock syndrome (DSS): 737/891 (82.7%) patients. 107/891 (12%) DSS cases were associated with other severe manifestations. Severe hemorrhage accounted for 90/891 (10.1%) patients. Among cases with organ involvement (211/891 - 23.7%), hepatic impairment was observed in 196/891 (22%) patients, renal impairment 25/891 (2.8%), cardiac impairment 14/891 (1.6%) and neurological impairment 13/891 (1.5%). 250/737 (33.9%) DSS patients developing ≥ 1 episode of recurrent shock. They were younger than those without recurrent shock (25.3 vs 28.4 years, p = 0.007). Factors associated with recurrent shock episodes were: having BMI ≥ 25 (OR: 1.65; 95% CI: 1.18; 2.3), day of illness ≤ 5 (OR: 2.16; 95% CI: 1.51; 3.09) and prior COVID-19 infection (OR: 2.57; 95% CI: 1.62-4.06). Indicators for the “associated severe phenotypes” (DSS associated with severe hemorrhage, with organ impairment, or both) were older age (p = 0.018) and presence of comorbidities (p ConclusionsUnderstanding the variability and complexity of severe dengue clinical manifestations, along with the different host factors associated with these features, will contribute to formulating suitable treatment guidelines for this at-risk population.研究背景：登革热在越南已呈地方流行多年，既往多数报告病例为儿童。近期流行病学数据显示，成人登革热病例占比呈上升趋势，尤以重症登革热为甚。新冠疫情后出现前所未有的疫情反弹，导致住院登革热病例数达到异常高位。本研究为回顾性研究，旨在描述2022年暴发期间越南成人重症登革热患者的临床表型与临床转归，并探索与疾病异质性及严重程度相关的宿主相关因素。 研究结果：本研究共纳入891例患者，平均年龄为29±10岁。其中284/891（31.9%）患者的体重指数（BMI, Body Mass Index）≥25 kg/m²，240/891（26.9%）存在合并症。最主要的重症临床表型为登革热休克综合征（DSS, Dengue Shock Syndrome）：共计737/891（82.7%）患者罹患该综合征。107/891（12%）的DSS病例合并其他重症临床表现。重症出血累及90/891（10.1%）患者。在存在器官受累的211/891（23.7%）病例中，肝功能损害196/891（22%）、肾功能损害25/891（2.8%）、心功能损害14/891（1.6%）以及神经功能损害13/891（1.5%）。737例DSS患者中，250例（33.9%）发生≥1次复发性休克。该组患者的年龄较无复发性休克患者更低（25.3岁 vs 28.4岁，p=0.007）。与复发性休克发作相关的因素包括：BMI≥25（比值比[OR, Odds Ratio]：1.65；95%置信区间[CI, Confidence Interval]：1.18~2.3）、发病天数≤5（OR：2.16；95%CI：1.51~3.09）以及既往新冠病毒感染（OR：2.57；95%CI：1.62~4.06）。与"合并重症表型"（DSS合并重症出血、合并器官损害，或两者兼具）相关的指标为：年龄更大（p=0.018）及存在合并症。 研究结论：明晰重症登革热临床表现的异质性与复杂性，以及与之相关的各类宿主因素，将有助于为这一高危人群制定适宜的治疗指南。