Fatal Dengue Hemorrhagic Fever in Adults Emphasizing the Evolutionary Pre-fatal Clinical and Laboratory Manifestations 英文参考文献.docVIP

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Fatal Dengue Hemorrhagic Fever in Adults Emphasizing the Evolutionary Pre-fatal Clinical and Laboratory Manifestations 英文参考文献.doc

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Fatal Dengue Hemorrhagic Fever in Adults Emphasizing the Evolutionary Pre-fatal Clinical and Laboratory Manifestations 英文参考文献

FatalDengueHemorrhagicFeverinAdults:Emphasizing theEvolutionaryPre-fatalClinicalandLaboratory Manifestations Ing-KitLee1,2,Jien-WeiLiu1,2*,KuenderD.Yang3 1DivisionofInfectiousDiseases,DepartmentofInternalMedicine,KaohsiungChangGungMemorialHospital,Kaohsiung,Taiwan,2ChangGungUniversityCollegeof Medicine,Kaohsiung,Taiwan,3DepartmentofPediatrics,ShowChwanMemorialHospital,Changhua,Taiwan Abstract Background:Abetterdescriptionoftheclinicalandlaboratorymanifestationsoffatalpatientswithdenguehemorrhagic fever(DHF)isimportantinalertingcliniciansofseveredengueandimprovingmanagement. MethodsandFindings:Of309adultswithDHF,10fatalpatientsand299survivors(controls)wereretrospectivelyanalyzed. Regardingcausesoffatality,massivegastrointestinal(GI)bleedingwasfoundin4patients,dengueshocksyndrome(DSS) alonein2;DSS/subarachnoidhemorrhage,Klebsiellapneumoniaemeningitis/bacteremia,ventilatorassociatedpneumonia, andmassiveGIbleeding/Enterococcusfaecalisbacteremiaeachinone.Fatalpatientswerefoundtohavesignificantlyhigher frequenciesofearlyalteredconsciousness(#24hafterhospitalization),hypothermia,GIbleeding/massiveGIbleeding,DSS, concurrentbacteremiawith/withoutshock,pulmonaryedema,renal/hepaticfailure,andsubarachnoidhemorrhage.Among thoseexperiencedearlyalteredconsciousness,massiveGIbleedingalone/withuremia/withE.faecalisbacteremia,andK. pneumoniaemeningitis/bacteremiawereeachfoundinonepatient.Significantlyhigherproportionofbandemiafrominitial (arrival)laboratorydatainfatalpatientsascomparedtocontrols,andhigherproportionofpre-fatalleukocytosisandlower pre-fatalplateletcountascomparedtoinitiallaboratorydataoffatalpatientswerefound.MassiveGIbleeding(33.3%)and bacteremia(25%)werethemajorcausesofpre-fatalleukocytosisinthedeceasedpatients;33.3%ofthepatientswithpre- fatalprofoundthrombocytopenia(,20000/mL),and50%ofthepatientswithpre-fatalprothrombintime(PT)prolongation experiencedmassiveGIbleeding. Conclusions: Our report highlights causes of fatality other than DSS in patients with severe den