Risk factors associated with in-hospital mortality during yellow fever outbreak in Brazil
ObjectiveTo characterize the clinical manifestations of yellow fever disease and identify risk factors for mortality.MethodsA retrospective study was conducted in the referral center for infectious diseases (Hospital Eduardo de Menezes-HEM) in Belo Horizonte, Minas Gerais, Brazil. Analysis included...
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Frontiers Media S.A.
2025-01-01
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| author | Max McClure Izabela Maurício de Rezende Leonardo Soares Pereira Maria Rita Teixeira Dutra Jordana Rodrigues Barbosa Fradico Rodrigo Macedo Marcelle Cardoso Marçal Lívia Soares Coelho Fonte Boa Alexandre Maurício Castro Bragato Flávio Augusto de Almeida Faria Livia Pamplona Rodrigo Fabiano do Carmo Said Carlos Eduardo Calzavara-Silva Dario Brock Ramalho Cintia Lopes de Brito Magalhães Pedro Augusto Alves Thaysa Drummond Palmeira Gama Gláucia Fernandes Cota Thomas P. Monath Olindo Assis Martins-Filho Marcelo Antônio Pascoal-Xavier Andrea Teixeira-Carvalho Betânia Paiva Drumond A. Desiree LaBeaud Yellow Fever Collaborative Group Argus Leão Araújo Barbara Lenoir Bruno Dala Vedova Gomes Beato Carolina Lins Rodrigues Vieira Daniel Vitor de Vasconcelos Santos Flavia Mansur Starling Gabriela Miana de Mattos Paixão Indiara Penido Izabela Aparecida Coelho Leandro Henrique Malta Cunha Letícia Menezes Livia Frota Rabelo Letícia Lemos Jardim Lívia Fulgêncio da Cunha Melo Lívia Zignago Moreira dos Santos Ludmila de Paula Luísa Lages de Abre Paladino Natalia Soares Albuquerque Simone Lopes Oliveira Lemos Tayrine Araújo |
| author_facet | Max McClure Izabela Maurício de Rezende Leonardo Soares Pereira Maria Rita Teixeira Dutra Jordana Rodrigues Barbosa Fradico Rodrigo Macedo Marcelle Cardoso Marçal Lívia Soares Coelho Fonte Boa Alexandre Maurício Castro Bragato Flávio Augusto de Almeida Faria Livia Pamplona Rodrigo Fabiano do Carmo Said Carlos Eduardo Calzavara-Silva Dario Brock Ramalho Cintia Lopes de Brito Magalhães Pedro Augusto Alves Thaysa Drummond Palmeira Gama Gláucia Fernandes Cota Thomas P. Monath Olindo Assis Martins-Filho Marcelo Antônio Pascoal-Xavier Andrea Teixeira-Carvalho Betânia Paiva Drumond A. Desiree LaBeaud Yellow Fever Collaborative Group Argus Leão Araújo Barbara Lenoir Bruno Dala Vedova Gomes Beato Carolina Lins Rodrigues Vieira Daniel Vitor de Vasconcelos Santos Flavia Mansur Starling Gabriela Miana de Mattos Paixão Indiara Penido Izabela Aparecida Coelho Leandro Henrique Malta Cunha Letícia Menezes Livia Frota Rabelo Letícia Lemos Jardim Lívia Fulgêncio da Cunha Melo Lívia Zignago Moreira dos Santos Ludmila de Paula Luísa Lages de Abre Paladino Natalia Soares Albuquerque Simone Lopes Oliveira Lemos Tayrine Araújo |
| author_sort | Max McClure |
| collection | DOAJ |
| description | ObjectiveTo characterize the clinical manifestations of yellow fever disease and identify risk factors for mortality.MethodsA retrospective study was conducted in the referral center for infectious diseases (Hospital Eduardo de Menezes-HEM) in Belo Horizonte, Minas Gerais, Brazil. Analysis included data from 283 patients with confirmed YF infection older than 13 years old who presented to HEM between January 2017 and June 2018. In-hospital mortality (hypothesis formulated after data collection), demographic factors and clinical and laboratory assessments were used.ResultsStudy patients were mainly men (87.6%), with a median age of 46.0 (IQR 36.5, 57.0). 131 (46.3%) patients were admitted to the ICU, and 62 (22.0%) used invasive mechanical ventilation for a median of 2 days (IQR 1, 3). The median (IQR) total length of stay (LOS) in the ICU was 6 days (IQR 4, 8). The in-hospital mortality rate was 24.0%. Age was significantly higher in fatal (median 49.5, IQR 41.0, 61.0]) than in non-fatal cases [46 (36, 55)] (p < 0.01). Male sex was associated with an increased risk of death (RR 4.66, 95% CI 1.19, 18.2; p < 0.01). Most common symptoms and signs on admission to HEM were fever (31.9%), myalgia (27.8%), jaundice (24.3%), headache (23.9%), abdominal pain (16.1%), vomiting (12.2%), weakness (10.4%), and arthralgias (10.0%). Initial viral load above the cutoff of 4.45 log10 copies/mL was significantly associated with death prior to discharge (OR 12.2; CI 2.83, 92.3). Five factors were significantly related to increased odds of death prior to discharge: log-transformed AST (OR 3.65; CI 2.02, 7.81; p < 0.001), log-transformed INR (OR 7.40; CI 1.31, 33.0; p = 0.010), log-transformed lactate (OR 4.57; CI 1.48, 17.1; p = 0.013), log-transformed WBC (OR 4.33; CI 1.19, 18.5; p = 0.034), and age (OR 1.06; CI 1.01, 1.12; p = 0.026).Conclusions and relevanceAST, INR, lactate, WBC, and age are statistically associated with death prior to discharge in YF patients. These clinical markers should be applied to improve patient screening and management during future YF epidemics. |
| format | Article |
| id | doaj-art-958b464d9aeb4dcb9f89b3ea905c41d8 |
| institution | Kabale University |
| issn | 2296-858X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj-art-958b464d9aeb4dcb9f89b3ea905c41d82025-01-27T05:14:33ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-01-011210.3389/fmed.2025.15050051505005Risk factors associated with in-hospital mortality during yellow fever outbreak in BrazilMax McClure0Izabela Maurício de Rezende1Leonardo Soares Pereira2Maria Rita Teixeira Dutra3Jordana Rodrigues Barbosa Fradico4Rodrigo Macedo5Marcelle Cardoso Marçal6Lívia Soares Coelho Fonte Boa7Alexandre Maurício Castro Bragato8Flávio Augusto de Almeida Faria9Livia Pamplona10Rodrigo Fabiano do Carmo Said11Carlos Eduardo Calzavara-Silva12Dario Brock Ramalho13Cintia Lopes de Brito Magalhães14Pedro Augusto Alves15Thaysa Drummond Palmeira Gama16Gláucia Fernandes Cota17Thomas P. Monath18Olindo Assis Martins-Filho19Marcelo Antônio Pascoal-Xavier20Andrea Teixeira-Carvalho21Betânia Paiva Drumond22A. Desiree LaBeaud23Yellow Fever Collaborative GroupArgus Leão AraújoBarbara LenoirBruno Dala Vedova Gomes BeatoCarolina Lins Rodrigues VieiraDaniel Vitor de Vasconcelos SantosFlavia Mansur StarlingGabriela Miana de Mattos PaixãoIndiara PenidoIzabela Aparecida CoelhoLeandro Henrique Malta CunhaLetícia MenezesLivia Frota RabeloLetícia Lemos JardimLívia Fulgêncio da Cunha MeloLívia Zignago Moreira dos SantosLudmila de PaulaLuísa Lages de Abre PaladinoNatalia Soares AlbuquerqueSimone Lopes Oliveira LemosTayrine AraújoDivision of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United StatesDivision of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United StatesEduardo de Menezes Hospital, Belo Horizonte, BrazilEduardo de Menezes Hospital, Belo Horizonte, BrazilIntegrated Group of Biomarkers Research, Instituto René Rachou, Fundação Oswaldo Cruz (Fiocruz), Belo Horizonte, BrazilEduardo de Menezes Hospital, Belo Horizonte, BrazilEduardo de Menezes Hospital, Belo Horizonte, BrazilEduardo de Menezes Hospital, Belo Horizonte, BrazilEduardo de Menezes Hospital, Belo Horizonte, BrazilEduardo de Menezes Hospital, Belo Horizonte, BrazilEduardo de Menezes Hospital, Belo Horizonte, BrazilPan American Health Organization, Brasília, BrazilCellular and Molecular Immunology, Instituto René Rachou, Fundação Oswaldo Cruz (Fiocruz), Belo Horizonte, BrazilEduardo de Menezes Hospital, Belo Horizonte, BrazilResearch Center in Biological Sciences, Universidade Federal de Ouro Preto, Ouro Preto, BrazilImmunology of Viral Diseases, Instituto René Rachou, Fundação Oswaldo Cruz (Fiocruz), Belo Horizonte, BrazilEduardo de Menezes Hospital, Belo Horizonte, BrazilInstituto René Rachou, Fundação Oswaldo Cruz (Fiocruz), Belo Horizonte, Brazil0Crozet BioPharma LLC, Lexington, MA, United StatesIntegrated Group of Biomarkers Research, Instituto René Rachou, Fundação Oswaldo Cruz (Fiocruz), Belo Horizonte, BrazilImmunology of Viral Diseases, Instituto René Rachou, Fundação Oswaldo Cruz (Fiocruz), Belo Horizonte, BrazilIntegrated Group of Biomarkers Research, Instituto René Rachou, Fundação Oswaldo Cruz (Fiocruz), Belo Horizonte, Brazil1Laboratory of Viruses, Microbiology Department, Biological Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, BrazilDivision of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United StatesObjectiveTo characterize the clinical manifestations of yellow fever disease and identify risk factors for mortality.MethodsA retrospective study was conducted in the referral center for infectious diseases (Hospital Eduardo de Menezes-HEM) in Belo Horizonte, Minas Gerais, Brazil. Analysis included data from 283 patients with confirmed YF infection older than 13 years old who presented to HEM between January 2017 and June 2018. In-hospital mortality (hypothesis formulated after data collection), demographic factors and clinical and laboratory assessments were used.ResultsStudy patients were mainly men (87.6%), with a median age of 46.0 (IQR 36.5, 57.0). 131 (46.3%) patients were admitted to the ICU, and 62 (22.0%) used invasive mechanical ventilation for a median of 2 days (IQR 1, 3). The median (IQR) total length of stay (LOS) in the ICU was 6 days (IQR 4, 8). The in-hospital mortality rate was 24.0%. Age was significantly higher in fatal (median 49.5, IQR 41.0, 61.0]) than in non-fatal cases [46 (36, 55)] (p < 0.01). Male sex was associated with an increased risk of death (RR 4.66, 95% CI 1.19, 18.2; p < 0.01). Most common symptoms and signs on admission to HEM were fever (31.9%), myalgia (27.8%), jaundice (24.3%), headache (23.9%), abdominal pain (16.1%), vomiting (12.2%), weakness (10.4%), and arthralgias (10.0%). Initial viral load above the cutoff of 4.45 log10 copies/mL was significantly associated with death prior to discharge (OR 12.2; CI 2.83, 92.3). Five factors were significantly related to increased odds of death prior to discharge: log-transformed AST (OR 3.65; CI 2.02, 7.81; p < 0.001), log-transformed INR (OR 7.40; CI 1.31, 33.0; p = 0.010), log-transformed lactate (OR 4.57; CI 1.48, 17.1; p = 0.013), log-transformed WBC (OR 4.33; CI 1.19, 18.5; p = 0.034), and age (OR 1.06; CI 1.01, 1.12; p = 0.026).Conclusions and relevanceAST, INR, lactate, WBC, and age are statistically associated with death prior to discharge in YF patients. These clinical markers should be applied to improve patient screening and management during future YF epidemics.https://www.frontiersin.org/articles/10.3389/fmed.2025.1505005/fullyellow feveryellow fever virusmortalityclinical managementBrazil |
| spellingShingle | Max McClure Izabela Maurício de Rezende Leonardo Soares Pereira Maria Rita Teixeira Dutra Jordana Rodrigues Barbosa Fradico Rodrigo Macedo Marcelle Cardoso Marçal Lívia Soares Coelho Fonte Boa Alexandre Maurício Castro Bragato Flávio Augusto de Almeida Faria Livia Pamplona Rodrigo Fabiano do Carmo Said Carlos Eduardo Calzavara-Silva Dario Brock Ramalho Cintia Lopes de Brito Magalhães Pedro Augusto Alves Thaysa Drummond Palmeira Gama Gláucia Fernandes Cota Thomas P. Monath Olindo Assis Martins-Filho Marcelo Antônio Pascoal-Xavier Andrea Teixeira-Carvalho Betânia Paiva Drumond A. Desiree LaBeaud Yellow Fever Collaborative Group Argus Leão Araújo Barbara Lenoir Bruno Dala Vedova Gomes Beato Carolina Lins Rodrigues Vieira Daniel Vitor de Vasconcelos Santos Flavia Mansur Starling Gabriela Miana de Mattos Paixão Indiara Penido Izabela Aparecida Coelho Leandro Henrique Malta Cunha Letícia Menezes Livia Frota Rabelo Letícia Lemos Jardim Lívia Fulgêncio da Cunha Melo Lívia Zignago Moreira dos Santos Ludmila de Paula Luísa Lages de Abre Paladino Natalia Soares Albuquerque Simone Lopes Oliveira Lemos Tayrine Araújo Risk factors associated with in-hospital mortality during yellow fever outbreak in Brazil Frontiers in Medicine yellow fever yellow fever virus mortality clinical management Brazil |
| title | Risk factors associated with in-hospital mortality during yellow fever outbreak in Brazil |
| title_full | Risk factors associated with in-hospital mortality during yellow fever outbreak in Brazil |
| title_fullStr | Risk factors associated with in-hospital mortality during yellow fever outbreak in Brazil |
| title_full_unstemmed | Risk factors associated with in-hospital mortality during yellow fever outbreak in Brazil |
| title_short | Risk factors associated with in-hospital mortality during yellow fever outbreak in Brazil |
| title_sort | risk factors associated with in hospital mortality during yellow fever outbreak in brazil |
| topic | yellow fever yellow fever virus mortality clinical management Brazil |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2025.1505005/full |
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