Publication:

Clinico-laboratory spectrum of dengue fever and predictors of severe dengue infection: a study from a tertiary care hospital in Mumbai

Background Dengue is a rapidly spreading arboviral infection that can progress from flu-like illness to life-threatening severe forms. Since early prediction of severity is difficult, identifying clinical and laboratory predictors is essential for proper management.

Methods A total 200 patients of either gender and of age ≥18 years with confirmatory diagnosis of dengue fever by dengue NS1 ELISA and/or RT-PCR were enrolled in this study from August 2017 to November 2018. Detailed clinical history was documented.

Results Of 200 patients, 89% had non-severe (group A) and 11% had severe (group B). Common age group affected in both the groups were 18-30 years. In non-severe dengue, 7.3% patients presented with signs of bleeding as compared to 63.6% in severe dengue. Signs of plasma leakage were only seen in severe dengue (68.2%). Hepatomegaly was predominantly associated with severe dengue (90.9%) as compared to non-severe dengue (10.1%). Splenomegaly was noted from 31.8% patients with severe dengue as compared to only 1.7% patients with non-severe dengue. Secondary dengue infection was present in 2.2% of non-severe cases and 18.2% of severe cases. All patients with severe dengue had significantly higher viral load (≥1000 copies/ml) as compared to 78.7% patients with non-severe dengue.

Conclusions The possible predictors of severe dengue may include young age with symptoms like rash, vomiting, lethargy and dyspnoea having signs of bleeding, plasma leakage and organomegaly. In addition, laboratory findings supporting severity are secondary infection, high viral load, thrombocytopenia, high haematocrit, raised liver enzymes and increased serum creatinine.