Risk Factors for Death in Patients With Dengue Fever in Dhaka, Bangladesh: A Verbal Autopsy Study

Background Bangladesh experienced its highest-ever dengue mortality with more than 1,700 deaths in 2023. Despite this high mortality, the data related to causality and circumstances for the fatality of dengue patients in Bangladesh are very limited. The purpose of this study was to identify the clinical characteristics and risk factors related to deaths in dengue patients. Methods A verbal autopsy study was conducted between February to November 2024 from three dengue-dedicated hospitals in the Dhaka metropolitan area. Cases were identified from the hospital's registry, following ethical approval from the institutional review board. A total of 82 death cases were recorded between February and November 2024. Written informed consent was obtained from the caregivers of the 17 deceased cases for interviews who lived in Dhaka. We included 17 age-matched severe dengue survivors from these hospitals as the comparison group to identify the risk factors of dengue death. Results The median duration from symptom onset to death was five days (interquartile range (IQR): four to eight days) and from hospitalization to death was two days (IQR: one to four days). A total of 10 patients among the 17 (59%) died within the first three days of hospital admission, and the death rate was higher among women (11/17, 64.7%). Respiratory distress was significantly more common in deceased patients compared to survivors (p=0.016). As warning signs, the presence of four or more warning signs (p=0.017), persistent vomiting (p=0.013), and clinical fluid accumulation (p=0.001) were significant indicators of dengue fatality. Conclusion The results suggest that the presence of respiratory distress, persistent vomiting, clinical fluid accumulation, and multiple warning signs was found to be associated with dengue fatality. Early identification and prompt management may reduce deaths from dengue.