Clinical characteristics, risk factors, and outcomes of patients with dengue admitted to intensive care unit in a hyperendemic region

Introduction: In Brazil, approximately 18 million dengue cases have been reported over the past decade. The objective of this study was to describe the clinical profile, risk factors, laboratory findings, and complications of patients with dengue who required admission to the intensive care unit. Methods: This was a retrospective, single-center cohort study that included all adult patients with confirmed dengue admitted to the intensive care unit between 2019 and 2024. Cases were classified as severe dengue, dengue with warning signs, and dengue without warning signs according to the Pan American Health Organization criteria. Results: Among 1,703 hospitalized dengue cases, 8.6% required intensive care unit admission. Of these, 37.7% had severe dengue, 54.8% had dengue with warning signs, and 7.5% had dengue without warning signs. Overall, 77.4% developed clinical complications or severe manifestations. Among patients with severe dengue, the most frequent complications were bleeding (58.2%), sepsis or septic shock (56.4%), acute kidney injury (45.5%), and encephalopathy (41.8%). Overall intensive care unit mortality was 24.7%, reaching 58.2% in cases of severe dengue. Prolonged capillary refill time and tachycardia were independently associated with mortality in patients with severe dengue. Conclusion: In this hyperendemic region, a considerable proportion of hospitalized dengue patients required intensive care unit admission. Severe dengue was associated with high rates of complications and mortality. Keywords: dengue, severe dengue, shock, intensive care unit, critical care