Dados do Trabalho

Título

Risk factors associated with in hospital mortality during yellow fever outbreak in Brazil

Introdução

Yellow fever has been described for centuries in the Americas. However, due to its characteristics mainly occurring in remote areas, several gaps in YF pathogenesis and clinical course persist. The 2016-2018 outbreak

Objetivo (s)

To characterize the clinical manifestations of yellow fever and identify risk factors for mortality.

Material e Métodos

Design, Setting and Participants: Retrospective study based on the review of inpatient and outpatient medical records from a referral center for infectious diseases (Hospital Eduardo de Menezes - HEM) in Belo Horizonte, Brazil. Analysis included data from 283 patients with confirmed YF infection, older than 13 years old who presented to HEM between January 2017 and June 2018 with confirmed YF. Main Outcome and Measure: In-hospital mortality (hypothesis formulated after data collection). Demographic factors and clinical and laboratory assessments near the time of admission.

Resultados e Conclusão

Results: Study patients were mainly men (87.6%), with a median age of 46.0 (IQR 36.5, 57.0). 131 (46.3%) patients were admitted to the ICU, and 62 (22.0%) used invasive mechanical ventilation for a median of 2 days (IQR 1, 3). The median (IQR) total length of stay (LOS) in the ICU was 6 days (IQR 4, 8). The in-hospital mortality rate was 24.0%. Age was significantly higher in fatal (median 49.5, IQR 41.0, 61.0]) than in nonfatal cases (46 [36, 55]) (p<0.01). Male sex was associated with an increased risk of death (RR 4.66, 95% CI 1.19, 18.2; p<0.01). Most common symptoms and signs on admission to HEM were fever (31.9%), myalgia (27.8%), jaundice (24.3%), headache (23.9%), abdominal pain (16.1%), vomiting (12.2%), weakness (10.4%), and arthralgias (10.0%). Initial viral load above the cutoff of 4.45 log10 copies/mL was significantly associated with death prior to discharge (OR 12.2; CI 2.83, 92.3). Five factors were significantly related to increased odds of death prior to discharge: log-transformed AST (OR 3.65; CI 2.02, 7.81; p<0.001), log-transformed INR (OR 7.40; CI 1.31, 33.0; p=0.010), log-transformed lactate (OR 4.57; CI 1.48, 17.1; p=0.013), log-transformed WBC (OR 4.33; CI 1.19, 18.5; p=0.034), and age (OR 1.06; CI 1.01, 1.12; p=0.026). Conclusions and Relevance: AST, INR, lactate, WBC, and age are statistically associated with death prior to discharge in YF patients. These clinical markers should be applied to improve patient screening and management during future YF epidemics.

Palavras Chave

yellow fever; yellow fever virus; severe disease; in-hopistal morality