A Cross-Sectional Study Assessing the Clinical Traits of Patients With Dengue

Abstract

Background and objectives: Dengue fever has been prevalent in tropical and subtropical countries since the beginning of this century. Though its clinical features and impacts on various organs have been explored thoroughly, we still lack a concrete correlation among those traits. Hence, we carried out this study to evaluate various clinical parameters of patients with dengue infection. Moreover, we planned to determine the co-occurrence of the symptoms and correlate all clinical parameters.

Methods: This cross-sectional study ran from January to December 2024 at the Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, India. We enrolled adult dengue patients admitted to the KIMS medicine ward last year with a positive non-structural 1 protein (NS1) report. We slotted the participants into the following groups: severe dengue and dengue with and without warning signs. The warning signs are continuous vomiting, rapid decline in the platelet count, hepatomegaly > 2 cm, mucosal bleeding, and fluid accumulation. Severe dengue infection is often presented with either of the following symptoms: respiratory distress, impaired consciousness, shock, elevated liver enzymes, and severe bleeding. From their case sheets, we noted their clinical (e.g., hematological, hepatic, and renal) parameters during admission. In the study population, we evaluated the incidences of pleural effusion, ascites, gallbladder thickening, and hepatosplenomegaly. The co-occurrence of various symptoms was weighed with a heatmap diagram. We additionally correlated all clinical traits of the study participants. R software (version 4.4.2; R Foundation for Statistical Computing, Vienna, Austria) was deployed for statistical analysis and data visualization.

Results: One hundred twenty-one dengue patients were deemed eligible for this study. Their median age was 45.0 (33.0-56.0) years. Most were younger individuals (100, 83.6%) and males (100, 83.6%). Twenty-nine (24.0%) participants had severe dengue. Forty-two (34.7%) presented with some warning signs of dengue. Fifty (41.3%) participants had dengue without any warning signs. There were increased instances of gallbladder thickening (13), pleural effusion with ascites (11), and hepatosplenomegaly (19) among those with severe dengue. The median platelet counts were as follows: those with warning signs (43.5 (25.3-150.0) x 10⁹/L), those without warning signs (194.0 (178.3-210.0) x 10⁹/L), and severe dengue (25.0 (25.0-43.0) x 10⁹/L), respectively (p < 0.001). The liver enzymes are substantially increased among severe dengue patients. The co-occurrence of fever was highest with vomiting (41, 33.9%), followed by headache (39, 32.2%), body aches (36, 29.8%), and pain in the abdomen (32, 26.4%). Significant correlations were observed between durations of itching and skin rash (r = 0.96, p < 0.001), serum creatinine and urea (r = 0.82, p < 0.001), packed cell volume (PCV), and hemoglobin (r = 0.80, p < 0.001). Hospital stay was lengthened among the severe dengue patients.

Conclusion: The patients admitted with severe dengue infection experienced thrombocytopenia, raised liver enzymes, and increased hospital stays. They also had higher incidences of pleural effusion, ascites, hepatosplenomegaly, and gallbladder thickening. Fever was the most common symptom. We did not find a strong association of any clinical parameters with hospital stay.