Epidemiology and outcomes of patients hospitalized with Dengue: Protocol for a prospective public health surveillance study

Research questions:

1. For patients hospitalized with Dengue, what are the patterns of clinical presentation, illness severity, treatments received, and outcomes?
2. What are the patient and  treatment-related predictors of hospital mortality for the cohort of severe dengue patients admitted to ICUs?

Objectives:

1. To describe the clinical presentation, demographics, including socio-economic determinants, illness severity, biochemical and hematological abnormalities, treatments received (fluids, vasopressors, organ support strategies, antiviral and anti-inflammatory medications) and outcomes for all dengue patients admitted to participating hospitals and ICUs over a 6-month period.
2. To evaluate treatment-related predictors of mortality for the cohort of severe dengue patients admitted to ICUs using modern causal inference approaches.

Methods and Measurements:

Study design: Prospective public health surveillance protocol

Inclusion criteria: Patients diagnosed with suspected or confirmed dengue (based on laboratory confirmation or per WHO or respective Ministry of Health diagnostic criteria). and admitted to a participating hospital.

Exclusion criteria:  The only exclusion criteria would be lack of informed consent in jurisdictions that mandate the need for consent.

 Outcome measures:

Our aim is to describe the clinical presentation (duration of illness, symptoms), demographics including socio-economic determinants, co-morbidities, illness severity (clinical, biochemical, laboratory, need for organ support), treatments received (IV fluids [type, volume, duration], blood and blood product transfusions, organ support provided during hospital stay, experimental therapies [corticosteroids, plasma exchange, IV immunoglobulins etc.], and outcomes [survival, ICU and hospital length of stay). Where feasible, we will also collect information on viral serotype/genotype. We will also evaluate treatment-related predictors of survival for the cohort of severe dengue patients using modern causal inference methods such as target trial emulation with a specific focus on steroids, plasma exchange and IVIg.