Clinical-Epidemiological Profile of Hospitalized Dengue Patients in a Tertiary Hospital During the 2024 Epidemic: Low Adherence to Clinical Classification and Persistence of Cases After the Seasonal Peak

Dengue is an arboviral disease transmitted by Aedes aegypti, whose epidemiology in Brazil is characterized by seasonality and outbreaks associated with the four viral serotypes (DENV-1 to DENV-4). In 2024, an unprecedented epidemic was observed, with simultaneous circulation of all serotypes and predominance of DENV-1, totaling more than 6.6 million probable cases and nearly 6,000 confirmed deaths. Given this scenario, this study aimed to describe the clinical and demographic characteristics of patients seen in the emergency department and hospitalized with dengue diagnosis in a tertiary hospital in São Paulo, seeking to identify failures in care flow, with emphasis on adherence to the clinical classification recommended by the Ministry of Health. Retrospective study conducted through analysis of 352 medical records of patients hospitalized between January and June 2024, with confirmed dengue diagnosis. Patients whose hospitalization was motivated by a compatible clinical presentation were included. Records with early discharge against medical advice or incomplete data were excluded. Variables analyzed included clinical-demographic data, comorbidities, symptoms, laboratory tests, and adherence to clinical classification. Statistical analysis was descriptive. Most cases occurred between April and May (69.1%). Mean age was 47 years, with slight predominance of females (51.1%). Hypertension (23%) and diabetes (12.8%) were the most frequent comorbidities. The most common symptoms were fever (48%), nausea/vomiting (43.2%), and myalgia (42.3%). The most frequent laboratory abnormalities were thrombocytopenia and elevated transaminases. NS1 was positive in 90% of cases. Case fatality rate was 0.9%. Notably, 79% of patients were not classified by severity according to Ministry of Health criteria, and 85.2% did not have albumin measured. Although the clinical profile of hospitalized patients was consistent with the literature, a prolonged epidemic curve was observed, with hospitalizations extending into June, which deviates from the typical seasonal pattern in the Southeast. In addition, low adherence to the official clinical classification may have compromised risk stratification and appropriate management, highlighting the need for continuing education and review of care workflows in epidemic contexts.