Factors associated with dengue fatality in Fiji: a hospital-based case control study

Introduction: Fiji experienced a dengue serotype 3 outbreak in 2013-14 with a higher number of fatalities compared to an earlier outbreak of similar intensity. This study was conducted to determine the factors associated with dengue mortality during the 2014 outbreak. Methods: A matched case control study was conducted. Cases were patients who died of dengue (n=30) and controls were patients with laboratory confirmed dengue who were hospitalized and survived (n=90). A standardized data collection form was used to extract information from medical folders. Findings: In this study predictors of dengue death included, haemorrhagic manifestations (odds ratio(OR) 2.63, 95% confidence interval (CI) 1.09,6.36), abdominal tenderness (OR 4.32, 95%CI 1.10,17.03), leucocytosis (OR 2.92, 95%CI 1.29,29.74) and serum creatinine > 150mg/dl (OR 6.19, 95%CI 1.29,29.74) at admission and development of shock (OR 40.05, 95%CI 5.26,305.19) during hospital stay. Living in urban location was also associated with dengue fatality (OR 5.78, 95%CI 1.57,21.22). Conclusion: Findings of this study should be used by clinicians for prompt identification and appropriate treatment of dengue as well as for public health measures to reduce dengue related mortality in Fiji.