Clinical outcomes of dengue patients requiring intensive care in Brazil: A 10-year nationwide observational study

BACKGROUND: Dengue may lead to critical illness requiring intensive care unit (ICU) admission. Even though Brazil is one of the most affected countries worldwide, national data are limited. Understanding clinical severity and outcomes is essential to inform policy and preparedness. METHODS: We conducted a retrospective study of adult dengue ICU admissions in Brazil from 2015 to 2024 using aggregated data from two nationwide complementary datasets: the Brazilian ICU registry (UTIs Brasileiras) and DATASUS Hospital Information System. The registry dataset includes clinical, severity, and organ-support variables from public and private institutions, while DATASUS captures public-system (SUS) reimbursed hospitalizations. Outcomes were ICU and in-hospital mortality, organ support, and length of stay. RESULTS: We identified 32,016 episodes of dengue admissions in the ICU registry and 11,241 in DATASUS. Data from the registry for the first 24 h of ICU shows mechanical ventilation use in 5.8% and vasopressors use in 7.2%. In-hospital mortality was 8.2% in the ICU registry. In DATASUS, in-hospital mortality was 18.6%. Patients admitted to public hospitals in the ICU registry had unadjusted ICU mortality of 20% and in-hospital mortality of 25%. Unadjusted mortality rates were higher in subgroups like older patients and those in use of vasopressors. CONCLUSION: Dengue requiring ICU admission in Brazil is associated with significant morbimortality. Mortality rates were higher in subgroups such as old patients and those admitted to public hospitals. Further studies are necessary to identify the potentially modifiable, organizational and patient-level factors associated with outcomes.