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In dengue virus (DENV) infection, acute kidney injury (AKI) frequency varies from 0.9% to 30.7% and is associated with longer hospital stay and increased mortality. Dengue in pregnancy increases the risk for adverse maternal and fetal outcomes, including the development of AKI. AKI is one of the least studied complications of DENV infection, especially during pregnancy. Yucatan is a dengue endemic area, being the first place in confirmed cases in Mexico as of September 2023. The General Hospital Dr. Agustín O’Horán, a second level care unit is a referral hospital for uninsured pregnant patients from the southeast of Mexico. The aim of our study was to describe the prevalence, clinical features and outcomes related to AKI in DENV infection during pregnancy in our hospital, from January to September 2023.
This was a retrospective study in an obstetric intensive care unit (OICU) in the General Hospital Dr Agustín O’Horán in Merida, Yucatan, Mexico. We included women during pregnancy and postpartum periods, with confirmed DENV infection between January to September 2023. Demographical, clinical and laboratory data were collected from medical records. AKI was diagnosed according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We evaluated the prevalence, clinical features and outcomes related to AKI in DENV infection during pregnancy.
Forty-two patients admitted to the OICU were identified with confirmed DENV infection. The mean age was 21.5 years old. Six (14.3%) women presented in the first trimester, 13 (31.0%) in the second trimester, 11 (26.2%) in the third trimester and 12 (28.6%) in the postpartum period. According to the 2009 World Health Organization (WHO) dengue classification, 31 (73.8%) had dengue with warning signs and 11 (26.2%) had severe dengue. Ten women developed AKI, with a prevalence of 23.8%. Those who developed AKI had a tendency to lower blood pressure measurements (systolic blood pressure 105 vs 112, p = 0.095; and diastolic blood pressure 63 vs 71, p = 0.015), and grater disseminated intravascular coagulation (DIC) International Society on Thrombosis and Haemostasis (ISTH) score (4 vs 2, p = 0.004). Alanine aminotransferase or aspartate aminotransferase levels greater than 1000 IU/L were more common in patients with AKI (30.0% vs 3.1%, p = 0.012). Patients with AKI had a longer stay in the OICU (5.3 days vs 3.3 days, p = 0.006), and greater use of mechanical ventilation (40.0% vs 3.1%, p = 0.002), vasopressor (40.0% vs 3.1%, p = 0.002), and blood transfusion (50.0% vs 6.3%, p = 0.002). The women with AKI had higher mortality (30.0% vs 0%, p = 0.001) and postpartum hemorrhage (40.0% vs 3.1%, p = 0.002).
In patients with DENV infection during pregnancy, those who developed AKI had more adverse clinical and maternal outcomes. Hence, women in pregnancy and postpartum periods with DENV infection should be monitored for the development of AKI and offer appropriate therapy to reduce adverse outcomes.