Yellow fever: profile of cases and factors associated with death in a hospital in the State of Rio de Janeiro, 2017-2018

Describe the clinical and epidemiological profile of confirmed cases of yellow fever whose patients were hospitalized in a general hospital for infectious diseases in the State of Rio de Janeiro, Brazil, from March 11, 2017 to June 15, 2018, during a recent outbreak and factors associated with death...

Full description

Saved in:

Bibliographic Details
Published in:	Revista de saúde pública Vol. 53; p. 89
Main Authors:	Escosteguy, Claudia Caminha, Pereira, Alessandra Gonçalves Lisbôa, Marques, Marcio Renan Vinícius Espínola, Lima, Tatiana Rodrigues de Araujo, Galliez, Rafael Mello, Medronho, Roberto de Andrade
Format:	Journal Article
Language:	English
Published:	Brazil Faculdade de Saúde Pública da Universidade de São Paulo 01-01-2019 Universidade de São Paulo
Subjects:	Adolescent Adult Aged Alanine Transaminase - blood Aspartate Aminotransferases - blood Bilirubin - blood Brazil - epidemiology Creatinine - blood Disease Outbreaks - statistics & numerical data Epidemiology, Descriptive Female Health Policy & Services Hospital Mortality Humans Logistic Models Male Middle Aged Multivariate Analysis Original Reference Values Retrospective Studies Risk Factors Statistics, Nonparametric Time Factors Urea - blood Yellow Fever - blood Yellow Fever - mortality Yellow Fever, epidemiology Young Adult Brazil Febre Amarela, epidemiologia Mortalidade Hospitalar Hospital Mortality Epidemiology, Descriptive Risk Factors Yellow Fever, epidemiology Fatores de Risco Epidemiologia Descritiva
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Describe the clinical and epidemiological profile of confirmed cases of yellow fever whose patients were hospitalized in a general hospital for infectious diseases in the State of Rio de Janeiro, Brazil, from March 11, 2017 to June 15, 2018, during a recent outbreak and factors associated with death. This is a retrospective observational study with analysis of secondary databases of local epidemiological surveillance system, and complementary data collection from epidemiological investigation records and clinical records. Study variables included demographic, epidemiological, clinical, and laboratory data. A descriptive statistical analysis and a bivariate and multivariate analysis by logistic regression were performed to analyze factors associated with death. Fifty-two patients diagnosed with yellow fever were hospitalized, 86.5% male patients, median age 49.5 years, 40.4% rural workers. The most frequent signs and symptoms were fever (90.4%), jaundice (86.5%), nausea and/or vomiting (69.2%), changes in renal excretion (53.8%), bleeding (50%), and abdominal pain (48.1%), with comorbidity in 38.5% of all cases. The lethality rate was 40.4%. Factors significantly associated with a higher chance of death in the bivariate analysis were: bleeding, changes in renal excretion, and maximum values of direct bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, and creatinine. In the multivariate analysis by logistic regression, only changes in renal excretion and ALT remained significant predictors of higher chance of death. A threshold effect was also observed for AST. The cutoff points identified as high risk for death were ALT > 4,000 U/L and AST > 6,000 U/L. This study contributed to the knowledge on the profile of confirmed cases of high severity yellow fever. The main factors associated with death were changes in renal excretion and elevated serum transaminases, especially ALT. High lethality emphasizes the need for early diagnosis and treatment, and the importance of increasing vaccination coverage.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23 Authors’ contribution: Study conception and planning: CCE. Data collection, analysis and interpretation: CCE, AGLP, MRVEM, TRAL, RMG, RAM. Text development or review: CCE, AGLP, MRVEM, TRAL, RMG, RAM. Approval of final version: CCE, AGLP, MRVEM, TRAL, RMG, RAM. Public responsibility for study content: CCE, AGLP, MRVEM, TRAL, RMG, RAM. Conflict of interest: The authors declare no conflict of interest.
ISSN:	0034-8910 1518-8787 1518-8787
DOI:	10.11606/S1518-8787.2019053001434