Objective:

To identify factors associated with death among patients with laboratory-confirmed severe dengue in Espírito Santo, Brazil, from 2020 through 2024, including exploratory age-related differences.

Approach:

• Study Design: A population-based retrospective cohort study using the state’s compulsory disease surveillance database.
• Outcome Assessment: Researchers classified 251 patients as fatal or nonfatal cases according to recorded dengue-related death.
• Statistical Analysis: Multivariable Poisson regression with robust variance estimated risk ratios. Exploratory analyses compared patients aged <60 years and ≥60 years.

Key Findings:

• Among 251 patients, 117 (46.6%) died. Fatal cases were significantly older than survivors.
• Weak or undetectable pulse, late-stage arterial hypotension, progressive hematocrit increase, and altered consciousness were associated with higher mortality in the overall multivariable model.
• Fever and a sudden platelet count decline were associated with lower mortality.
• Weak or undetectable pulse and late-stage hypotension remained associated with higher mortality in both age groups.
• Hematocrit increase and sudden platelet decline were associated with mortality only in patients aged <60 years; fever was associated with lower mortality only in those aged ≥60 years.

Interpretation:

Mortality is predominantly associated with advanced hemodynamic instability. Associations with lower mortality do not establish protective effects, and the findings do not demonstrate early predictive value.

Limitations:

• Surveillance data may be affected by underreporting or misclassification.
• The timing of individual manifestations relative to death was unavailable.
• Information on time to care, fluid management, medications, and socioeconomic factors was unavailable.
• Age-stratified findings are exploratory; formal interaction tests were not performed, and the age cutoff was selected using the study population.

Conclusion:

Established hemodynamic collapse is associated with mortality in severe dengue. Prospective studies with precisely timed clinical data are needed to investigate potential age-related differences.