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Gérardin P, Issop A, Diarra YM, Cousty J, Jaffar-Bandjee MC, Maillard O, Raffray L, Nobécourt E, Bertolotti A. Harness risk stratification of diabetic patients with dengue in a cohort study. J Infect Public Health 2024; 17:535-541. [PMID: 38310745 DOI: 10.1016/j.jiph.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/13/2023] [Accepted: 01/18/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Identifying predictors of severe dengue (SD) is key for triage and management of patients as well as for advising travellers to countries where dengue is endemic. In this, meta-analyses have raised diabetes mellitus as a risk factor for SD and a prognostic factor for dengue-related mortality. The purpose of this study was to assess whether diabetic patients (DPs) are at increased risk for SD in comparison to non-diabetic patients (NDPs) in a setting of high prevalence of type 2 diabetes mellitus and increasing endemicity for dengue. METHODS In a cohort study conducted during the 2019 dengue epidemic on Reunion Island, we estimated the risk ratios (RR) of DPs for SD (WHO 2009 definition), hospitalisation, intensive care unit (ICU) admission, critical care need or death in the ICU, and scales rating severity or multiple organ dysfunction syndrome (MODS), among confirmed cases of dengue (positive RT-PCR or NS1 antigen). RESULTS In a Poisson regression model adjusted for age, gender and comorbidity, DPs were more likely to develop SD (adjusted RR: 1.46, 95%CI 1.10-1.95), to be hospitalised, admitted to the ICU, and need critical care or die in the ICU. Subgroup analyses identified female DPs, non-elderly DPs (< 65 years) and DPs with low Charlson score (< 3) to be at higher risk for SD, the two first subgroups trough more severe presentation (higher Simplified Acute Physiology Score-2 values; higher MODS scores, respectively). Male gender, age less than 65 years and mixed comorbidity were identified as prognostic factors for critical care need or death in the ICU, male and non-elderly DPs being more likely to develop MODS than their non-diabetic counterparts. CONCLUSIONS Together, these data highlight the role of diabetes mellitus in the progression from dengue to SD through higher severity per se or the event of MODS.
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Affiliation(s)
- Patrick Gérardin
- INSERM, CIC 1410, Centre Hospitalier Universitaire Réunion, Saint-Pierre, La Réunion, France; Plateforme de Recherche Clinique et Translationnelle, Centre Hospitalier Universitaire Réunion, Saint-Pierre, La Réunion, France.
| | - Azizah Issop
- Service d'Endocrinologie et de Diabétologie, Centre Hospitalier Universitaire Réunion, Saint Pierre, La Réunion, France
| | - Yves-Marie Diarra
- INSERM, CIC 1410, Centre Hospitalier Universitaire Réunion, Saint-Pierre, La Réunion, France; UMR PIMIT (CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion), Sainte Clotilde, La Réunion, France
| | - Julien Cousty
- Service de Réanimation Polyvalente et de Soins Continus, Centre Hospitalier Universitaire Réunion, Saint Pierre, La Réunion, France
| | - Marie-Christine Jaffar-Bandjee
- Centre National de Référence associé des arbovirus, Centre Hospitalier Universitaire Réunion, Pôle de Biologie, Saint Denis, La Réunion, France
| | - Olivier Maillard
- INSERM, CIC 1410, Centre Hospitalier Universitaire Réunion, Saint-Pierre, La Réunion, France
| | - Loïc Raffray
- UMR PIMIT (CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion), Sainte Clotilde, La Réunion, France; Service de Médecine Interne, Centre Hospitalier Universitaire Réunion, Saint Denis, La Réunion, France
| | - Estelle Nobécourt
- INSERM, CIC 1410, Centre Hospitalier Universitaire Réunion, Saint-Pierre, La Réunion, France; Service d'Endocrinologie et de Diabétologie, Centre Hospitalier Universitaire Réunion, Saint Pierre, La Réunion, France; UMR Diabète Athérothrombose Thérapies Réunion Océan Indien (DéTROI) (INSERM U1188), Plateforme CYROI, University of La Réunion, Sainte Clotilde, La Réunion, France
| | - Antoine Bertolotti
- INSERM, CIC 1410, Centre Hospitalier Universitaire Réunion, Saint-Pierre, La Réunion, France; Service des Maladies Infectieuses, Médecine Interne, Dermatologie, Centre Hospitalier Universitaire Réunion, Saint Pierre, La Réunion, France
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