Long-term Functional, Cognitive, and Inflammatory Outcomes After Dengue and Septic Shock in Vietnam
Overview
This prospective study followed adult survivors of dengue shock (DS) and septic shock (SS) in Vietnam, assessing cognitive function, quality of life, endothelial function, and inflammatory biomarkers up to 6 months post-discharge. Survivors of DS showed recovery of cognitive function by 3 months, while SS survivors had persistent cognitive impairment. Both groups exhibited persistent subclinical inflammation, evidenced by elevated IL-6 and ferritin levels, without significant endothelial activation.
Background
Survivors of severe infections often experience prolonged physical, cognitive, and psychological impairments, potentially due to ongoing inflammation and immune dysregulation. Elevated inflammatory markers at hospital discharge correlate with worse long-term outcomes. While endothelial dysfunction is common during acute infectious shock, its persistence post-discharge is poorly understood, especially in low-middle income countries like Vietnam. Dengue shock and septic shock are leading causes of infectious shock in Vietnam, yet their long-term sequelae remain unstudied.
Data Highlights
Parameter
Dengue Shock (DS)
Septic Shock (SS)
Healthy Controls
EQ-5D-5L VAS at Discharge (Median [IQR])
>90/100
80/100 [70;95]
Not reported
EQ-5D-5L VAS at 6 Months (Median [IQR])
>90/100
90/100 [80;95]
Not reported
MoCA Score at Discharge (Median [IQR])
23/30 [20;26]
17/30 [13;19]
≥26 (Normal)
MoCA Score at 3 Months (Median [IQR])
27/30 [25;29]
Not reported
≥26 (Normal)
MoCA Score at 6 Months (Median [IQR])
Not reported
20/30 [17;21]
≥26 (Normal)
IL-6 and Ferritin Levels Post-Discharge
Elevated vs controls (P < .01)
Elevated vs controls (P < .01)
Baseline
Ferritin >95th Percentile at 6 Months
38%
62%
Reference
Endothelial Activation Evidence
Minimal
Minimal
Baseline
Key Findings
Survivors of dengue shock had high health-related quality of life scores (>90/100) at all time points post-discharge.
Dengue shock survivors showed mild cognitive impairment at discharge (median MoCA 23/30) that normalized by 3 months (median 27/30).
Septic shock survivors had lower quality of life scores and persistent cognitive impairment, with median MoCA scores below normal threshold even at 6 months (20/30).
Both DS and SS groups exhibited persistently elevated inflammatory biomarkers (IL-6 and ferritin) up to 6 months post-discharge compared to healthy controls.
A substantial proportion of survivors had ferritin levels above the 95th percentile of controls at 6 months (38% DS, 62% SS), indicating ongoing subclinical inflammation.
There was little evidence of ongoing endothelial activation or dysfunction beyond the acute phase in both groups.
Clinical Implications
Persistent subclinical inflammation after dengue and septic shock may contribute to long-term morbidity, particularly cognitive impairment in septic shock survivors. Routine follow-up including cognitive assessment and inflammatory biomarker monitoring could identify patients at risk of prolonged recovery. Interventions targeting inflammation may be warranted to improve long-term outcomes in these populations.
Conclusion
This study provides the first evidence of persistent subclinical inflammation following dengue and septic shock in Vietnam, with differential recovery trajectories in cognitive function. Further research is needed to elucidate the clinical significance and potential therapeutic targets of this prolonged inflammatory state.
References
Author/Source/2024 -- Chronic Subclinical Inflammation and Long-term Functional and Cognitive Effects Following Dengue Shock and Septic Shock in Vietnam
