Risk factors predicting dengue hospitalization and disease severity in children and adolescents living in an endemic area of arbovirus transmission in Northeast Brazil (2017–2020)

Dengue remains a major public health threat worldwide, particularly in the pediatric population. Dengue illness can develop from infection with any of the four dengue virus serotypes (DENV1-4), ranging from mild fever to potentially life-threatening severe dengue. In children, most dengue infections present as an undifferentiated fever, making it difficult to distinguish dengue from several other common viral infections that frequently occur at early ages. Thus, the rapid identification of dengue cases followed by appropriate early interventions and management is crucial to improve clinical prognosis. In this study, we evaluated socio-demographic, clinical, and laboratory factors predictive of disease severity in children and adolescents in Northeast Brazil. Patients aged < 1–19 years old (n = 288) hospitalized with dengue in a reference hospital between 2017 and 2020 were included in the study. Dengue patients were classified as dengue with warning signs (DwWS) and severe dengue (SD). Individual and sociodemographic information was retrieved from the hospital’s epidemiological investigation forms. Clinical data and laboratory parameters collected at the time of admission to the hospital were extracted from the medical records. Out of 288 patients, 72.2% (208/288) were classified as DwWS. We observed a steady decline in the number of hospitalizations by SD in the pediatric population during the study period, including in the epidemic year of 2019. SD cases were more frequently observed in children aged 7–12 years old (OR = 3.72, 95%CI = 1.34–13.21) and with self-identified mixed (OR = 2.28, 95%CI = 1.22–4.52) and black (OR = 5.92, 95%CI = 1.73–21.1) race. Multivariate analysis showed irritability (OR = 3.69, 95%CI = 1.36–11.19), fluid accumulation (OR = 5.50, 95%CI = 1.51–23.63), and lethargy/restlessness (OR = 19.95, 95%CI = 6.47–73.23) as significant parameters predictive of SD at hospitalization. Binary logistic regression indicated that increased levels of aspartate aminotransferase (AST; p-value = 0.003), monocytes (p-value < 0.0001), basophils (p-value = 0.0003), and red cell distribution width (RDW) percentage (p-value = 0.005) at admission are among the laboratory parameters associated with SD in the study population. The socio-demographic (age and race), clinical signs and symptoms (irritability, fluid accumulation, and lethargy/restlessness), and laboratory parameters (AST, monocytes, basophils, and RDW) identified in our study can help clinicians in the prompt diagnosis of the disease and in identifying patients who require immediate intervention and intensive care.