In-Hospital Mortality in Mechanically Ventilated Children With Severe Dengue Fever: Explanatory Factors in a Single-Center Retrospective Cohort From Vietnam, 2013–2022

Objectives: Severe dengue fever complicated by critical respiratory failure requiring mechanical ventilation (MV) contributes to high mortality rates among PICU-admitted patients. This study aimed to identify key explanatory variables of fatality in mechanically ventilated children with severe dengue. Design: Retrospective cohort, from 2013 to 2022. Setting: PICU of the tertiary Children’s Hospital No. 2, in Vietnam. Patients: Two hundred children with severe dengue fever who received MV. Interventions: None. Measurements and Main Results: We analyzed clinical and laboratory data during the PICU stay. The primary outcome was 28-day in-hospital mortality. Backward stepwise multivariable logistic regression was performed to identify the explanatory variables associated with dengue-associated mortality at the initiation of MV. The model performance was assessed using C-statistics, calibration plot, and Brier score. The patients had a median age of 7 years (interquartile range, 4–9). Overall, 47 (24%) of 200 patients died in the hospital. Five factors were associated with greater odds of mortality: severe transaminitis (aspartate aminotransferase or alanine aminotransferase ≥ 1000 IU/L), high blood lactate levels, vasoactive-inotropic score (> 30), dengue encephalitis, and peak inspiratory pressure on MV. The model performance in training (test) sets was a C-statistic of 0.86 (0.84), a good calibration slope 1.0 (0.89), and a Brier score of 0.08. Conclusions: In our center, from 2013 to 2022, MV-experienced patients with severe dengue had a high mortality rate. The main explanatory factors associated with greater odds of death (related to critical liver injury, shock, and MV) may inform future practice in such critically ill patients.