Publication:

Beyond conventional markers: admission serum lactate levels as an early predictor of dengue disease severity: a retrospective cross-sectional study from a tertiary care hospital in Karachi, Pakistan

Background Dengue is a significant global health concern, with clinical manifestations ranging from mild fever to severe, life-threatening hemorrhagic shock. Despite the use of established warning signs, an effective biomarker for the early identification of severe cases remains elusive. This study aimed to investigate the utility of admission serum lactate levels as an early predictor of dengue disease severity.

Methods A retrospective cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan, reviewing medical records from 2018 to 2022. The study included adult patients aged 18 and above who were admitted with a primary diagnosis of dengue fever and had admission serum lactate levels available. Patients with pre-existing chronic liver or kidney disease were excluded. Data on demographic characteristics, comorbidities, laboratory results (including lactate, hematocrit, and platelet count), and disease outcomes such as ICU admission, intubation, and systemic complications (cardiovascular, ARDS, CNS, acute liver failure, AKI, and mortality) were collected. Data analysis was performed using IBM SPSS Statistics, with a p value of <0.05 considered statistically significant.

Results A total of 203 eligible patients were included in the final analysis. The study found a statistically significant association between higher median serum lactate levels and various indicators of disease severity. Higher lactate levels were significantly associated intubation, and mortality (p value <0.05). A weak negative correlation was also observed between admission lactate levels and platelet counts. No significant correlation was found between lactate and hematocrit levels.

Conclusions Admission serum lactate levels can serve as a valuable and early predictor of overall dengue disease severity. Higher lactate levels upon hospital admission are significantly associated with a range of severe outcomes, including cardiovascular complications, ARDS, acute liver failure, AKI, intubation, and mortality.