{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T11:47:59Z","timestamp":1793533679395,"version":"4.5.0"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T00:00:00Z","timestamp":1719273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100020591","name":"Universidad San Ignacio de Loyola","doi-asserted-by":"publisher","award":["USIL-2024"],"award-info":[{"award-number":["USIL-2024"]}],"id":[{"id":"10.13039\/100020591","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Dengue has emerged as an unprecedented epidemic in Peru, and it is anticipated that this issue will escalate further owing to climate change. This study aimed to determine the risk factors associated with death from dengue in patients treated at Hospital II in Pucallpa, Peru.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methodology<\/jats:title>\n<jats:p>This retrospective cohort study collected information from the medical records of patients with a diagnosis of dengue treated at Hospital II Pucallpa-Peru between January 2019 and March 2023. The primary outcome was death, and the secondary outcome was death, development of severe dengue, or Intensive Care Unit (ICU) admission. Cox regression models were used to determine risk factors.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Findings<\/jats:title>\n<jats:p>The clinical records of 152 patients were evaluated, with a median age of 27.5 years (interquartile range, 11\u201345). Among all patients, 29 (19.1%) developed severe dengue, 31 (20.4%) were admitted to the ICU, and 13 (8.6%) died during follow-up. In the survival analysis, bilirubin &gt;1.2 mg\/dL was associated with a higher risk of death aHR: 11.38 (95% CI: 1.2 106.8). Additionally, factors associated with poor prognosis included having 1 to 3 comorbidities aRR: 1.92 (1.2 to 3.2), AST \u2265251 U\/L aRR: 6.79 (2.2 to 21.4), history of previous dengue aRR: 1.84 (1.0 to 3.3), and fibrinogen \u2265400 mg\/dL aRR: 2.23 (1.2 to 4.1).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Significance<\/jats:title>\n<jats:p>Elevated bilirubin was associated with death from dengue, whereas an increase in comorbidities and a history of previous dengue were related to a poor prognosis of the disease. Early identification of severe dengue would be more feasible with improved access to laboratory testing, particularly in tropical areas with a high dengue incidence.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0305689","type":"journal-article","created":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T17:25:06Z","timestamp":1719336306000},"page":"e0305689","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":15,"title":["Risk factors associated with dengue complications and death: A cohort study in Peru"],"prefix":"10.1371","volume":"19","author":[{"given":"Cesar","family":"Copaja-Corzo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Flores-Cohaila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9277-2731","authenticated-orcid":true,"given":"Gustavo","family":"Tapia-Sequeiros","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Vilchez-Cornejo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Hueda-Zavaleta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stalin","family":"Vilcarromero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Santana-T\u00e9llez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 F.","family":"Parodi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujey","family":"Gomez-Colque","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9158-1108","authenticated-orcid":true,"given":"Vicente A.","family":"Benites-Zapata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,6,25]]},"reference":[{"key":"pone.0305689.ref001","unstructured":"MINSA. 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EsSalud. 2024. https:\/\/portal.essalud.gob.pe\/ (accessed Jan 10, 2024)."},{"key":"pone.0305689.ref018","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1016\/j.ijsu.2014.07.014","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration","volume":"12","author":"JP Vandenbroucke","year":"2014","journal-title":"Int J Surg Lond Engl"},{"key":"pone.0305689.ref019","unstructured":"CDC. Dengue Clinical Presentation | CDC. Cent. Dis. Control Prev. 2023; published online April 13. https:\/\/www.cdc.gov\/dengue\/healthcare-providers\/clinical-presentation.html (accessed Jan 10, 2024)."},{"key":"pone.0305689.ref020","unstructured":"EsSalud W. EsSalud implementa historia cl\u00ednica digital para atenci\u00f3n de asegurados | EsSalud. 2019. http:\/\/www.essalud.gob.pe\/essalud-implementa-historia-clinica-digital-para-atencion-de-asegurados\/ (accessed Jan 10, 2024)."},{"key":"pone.0305689.ref021","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1007\/BF01709751","article-title":"The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction\/failure. 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city","volume":"7","author":"R Mahmood","year":"2021","journal-title":"Heliyon"},{"key":"pone.0305689.ref025","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1111\/tmi.13797","article-title":"Risk factors for mortality in patients with dengue: A systematic review and meta-analysis","volume":"27","author":"GCL Chagas","year":"2022","journal-title":"Trop Med Int Health"},{"key":"pone.0305689.ref026","doi-asserted-by":"crossref","first-page":"125","DOI":"10.12998\/wjcc.v3.i2.125","article-title":"Dengue and its effects on liver","volume":"3","author":"J Samanta","year":"2015","journal-title":"World J Clin Cases WJCC"},{"key":"pone.0305689.ref027","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1186\/s13054-019-2663-7","article-title":"The SOFA score\u2014development, utility and challenges of accurate assessment in clinical trials","volume":"23","author":"S Lambden","year":"2019","journal-title":"Crit 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Virol"},{"key":"pone.0305689.ref034","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1111\/tmi.12425","article-title":"Factors associated with death from dengue in the state of Minas Gerais, Brazil: historical cohort study","volume":"20","author":"KB Campos","year":"2015","journal-title":"Trop Med Int Health"},{"key":"pone.0305689.ref035","first-page":"e0043","article-title":"Factors associated with deaths from dengue in a city in a metropolitan region in Southeastern Brazil: a case-control study","volume":"55","author":"SC de Sousa","year":"2022","journal-title":"Rev Soc Bras Med Trop"},{"key":"pone.0305689.ref036","first-page":"e0030","article-title":"Factors associated with death from dengue and chikungunya virus infection during an epidemic period in Northeast Brazil: A retrospective cohort study","volume":"56","author":"MFS de Mendon\u00e7a","year":"2023","journal-title":"Rev Soc Bras Med 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Hemostatic Abnormalities in Dengue Patients Admitted in a Multidisciplinary Intensive Care Unit: A Cross-sectional Study","volume":"22","author":"VK Sureshkumar","year":"2018","journal-title":"Indian J Crit Care Med Peer-Rev Off Publ Indian Soc Crit Care Med"},{"key":"pone.0305689.ref041","first-page":"111","article-title":"Predictors of spontaneous bleeding in dengue patients: a systematic review of the literature","volume":"49","author":"FA D\u00edaz-Quijano","year":"2008","journal-title":"Invest Clin"},{"key":"pone.0305689.ref042","doi-asserted-by":"crossref","first-page":"483","DOI":"10.7861\/clinmedicine.11-5-483","article-title":"Dengue","volume":"11","author":"J Whitehorn","year":"2011","journal-title":"Clin Med"},{"key":"pone.0305689.ref043","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1097\/MOH.0000000000000074","article-title":"Global assays of hemostasis","volume":"21","author":"KE Brummel-Ziedins","year":"2014","journal-title":"Curr Opin 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