{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T09:45:40Z","timestamp":1790070340359,"version":"4.0.1"},"reference-count":53,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:00:00Z","timestamp":1751587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Dengue mortality has traditionally been associated with severe thrombocytopenia and hemorrhagic complications. However, during 2024, dengue virus serotype 3 (DENV-3) increased significantly in western Mexico, leading to the emergence of a distinct clinical pattern. We conducted a retrospective cohort study of hospitalized dengue patients at the General Hospital of Colima (January\u2013August 2024). Clinical features, laboratory parameters, and outcomes were compared between survivors and non-survivors. Among 201 hospitalized patients, 6 (3.0%) died. All deceased patients presented with generalized seizures, polyserositis (pleural effusion and\/or ascites), and required mechanical ventilation. Contrary to classical patterns, they did not have severe thrombocytopenia. Instead, they showed significantly higher white blood cell counts and notably increased levels of serum urea and BUN, suggesting early renal impairment. ROC analysis indicated that BUN (AUC 0.904) and urea (AUC 0.906) were good to excellent discriminators of mortality. During 2024, with an increase in DENV-3 circulation, mortality was associated with neurological and systemic complications, including seizures and polyserositis, as well as biochemical evidence of renal dysfunction\u2014but not with severe thrombocytopenia. These findings challenge current paradigms and highlight the need for early recognition of atypical clinical patterns.<\/jats:p>","DOI":"10.3390\/v17070950","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T11:19:27Z","timestamp":1751887167000},"page":"950","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Unexpected Predictors of Mortality During a DENV-3 Outbreak in Western Mexico: Seizures, Polyserositis, and Renal Dysfunction Without Severe Thrombocytopenia"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7646-0842","authenticated-orcid":false,"given":"Martha A.","family":"Mendoza-Hernandez","sequence":"first","affiliation":[{"name":"Hospital General de Manzanillo IMSS-Bienestar, Av. El\u00edas Zamora Verduzco S\/N, Nuevo Salagua, Manzanillo City 28869, Mexico"},{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima City 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3295-4768","authenticated-orcid":false,"given":"Janet","family":"Diaz-Martinez","sequence":"additional","affiliation":[{"name":"Research Center in Minority Institutions, Department of Dietetics and Nutrition, Florida International University (FIU-RCMI), Miami, FL 33199, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4685-3095","authenticated-orcid":false,"given":"Gustavo A.","family":"Hern\u00e1ndez-Fuentes","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima City 28040, Mexico"},{"name":"Faculty of Chemical Sciences, University of Colima, Coquimatlan City 28400, Mexico"},{"name":"State Cancerology Institute of Colima, Health Services of the Mexican Social Security Institute for Welfare (IMSS-BIENESTAR), Colima City 28085, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1744-9173","authenticated-orcid":false,"given":"Fabian","family":"Rojas-Larios","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima City 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katya A.","family":"C\u00e1rdenas-C\u00e1rdenas","sequence":"additional","affiliation":[{"name":"Hospital General de Manzanillo IMSS-Bienestar, Av. El\u00edas Zamora Verduzco S\/N, Nuevo Salagua, Manzanillo City 28869, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1688-7171","authenticated-orcid":false,"given":"Paulina","family":"Garc\u00eda de Le\u00f3n-Flores","sequence":"additional","affiliation":[{"name":"Hospital General de Manzanillo IMSS-Bienestar, Av. El\u00edas Zamora Verduzco S\/N, Nuevo Salagua, Manzanillo City 28869, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Rojas-Cruz","sequence":"additional","affiliation":[{"name":"Hospital General de Manzanillo IMSS-Bienestar, Av. El\u00edas Zamora Verduzco S\/N, Nuevo Salagua, Manzanillo City 28869, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Aceves-Calvario","sequence":"additional","affiliation":[{"name":"Hospital General de Manzanillo IMSS-Bienestar, Av. El\u00edas Zamora Verduzco S\/N, Nuevo Salagua, Manzanillo City 28869, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernesto","family":"G\u00f3mez-Sandoval","sequence":"additional","affiliation":[{"name":"Hospital General de Manzanillo IMSS-Bienestar, Av. El\u00edas Zamora Verduzco S\/N, Nuevo Salagua, Manzanillo City 28869, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Montserrat","family":"\u00c1rciga-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Hospital General de Manzanillo IMSS-Bienestar, Av. El\u00edas Zamora Verduzco S\/N, Nuevo Salagua, Manzanillo City 28869, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6727-0051","authenticated-orcid":false,"given":"Jos\u00e9","family":"Guzm\u00e1n-Esquivel","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Research Unit, Mexican Institute of Social Security, Villa de Alvarez 28984, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valery","family":"Melnikov","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima City 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1111-6845","authenticated-orcid":false,"given":"Francisco","family":"Espinoza-G\u00f3mez","sequence":"additional","affiliation":[{"name":"Regional University Hospital (IMSS-Bienestar), Health Services of the State of Colima, Colima City 28060, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9848-862X","authenticated-orcid":false,"given":"Iv\u00e1n","family":"Delgado-Enciso","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima City 28040, Mexico"},{"name":"State Cancerology Institute of Colima, Health Services of the Mexican Social Security Institute for Welfare (IMSS-BIENESTAR), Colima City 28085, Mexico"},{"name":"Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,4]]},"reference":[{"key":"ref_1","unstructured":"(2025, June 02). 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