ĐẶC ĐIỂM VÀ KẾT QUẢ ĐIỀU TRỊ BAN ĐẦU TĂNG PHẢN ỨNG VIÊM NẶNG TRONG SỐT XUẤT HUYẾT DENGUE TẠI BỆNH VIỆN NHI ĐỒNG 1

Abstract

Background: Severe hyperinflammation is a rare but potentially life-threatening complication in patients with DHF.

Objectives: To describe the epidemiological, clinical, and laboratory characteristics, organ involvement, and treatment outcomes of severe hyperinflammation in pediatric patients with Dengue.

Methods: A case series study was conducted on 12 pediatric patients diagnosed with Dengue-associated severe hyperinflammation at Children’s Hospital 1 from September 2025 to January 2026.

Results: Twelve cases of Dengue with severe hyperinflammation were identified during the study period. The male-to-female ratio was 2:1. Children aged 1–13 years accounted for 83.3% of cases, and 83.3% were overweight or obese. None had a prior history of Dengue infection or dengue vaccination. The proportion of shock at admission was 33.3%. Before initiation of immunomodulatory therapy, 50.0% had shock, 100.0% had organ dysfunction, and 25.0% had severe bleeding. All patients presented with fever ≥7 days, hepatomegaly, and respiratory failure. The most common laboratory findings were ferritin ≥5,000 µg/L and AST ≥1,000 U/L (100% of cases); 75% had fibrinogen <1.5 g/L, and 66.7% had cytopenia affecting at least two hematologic cell lines. All patients received dexamethasone. Additional interventions included mechanical ventilation (41.7%), continuous renal replacement therapy (41.7%), and plasma exchange (25.0%). From day 0 to day 7, body temperature, heart rate, AST, ALT, and ferritin levels significantly decreased over time (p < 0.05). The overall mortality rate was 33.3%, primarily due to intracranial hemorrhage and hospital-acquired infection.

Conclusions: Severe hyperinflammation in pediatric Dengue is characterized by prolonged fever, marked hyperferritinemia, severe hepatic injury, and high mortality. Early recognition and timely immunomodulatory therapy combined with intensive supportive care may improve clinical outcomes.