A double whammy: The association between comorbidities and severe dengue among adult patients-A matched case-control study

Ng, Wei Yao and Atan, Rafidah and Yunos, Nor'azim Mohd and Kamal, Adam Harrish bin Md and Roslan, Mohd Hariz and Quah, Kai Yuan and Teh, Kai Xuan and Zaid, Masliza and Kassim, Mahazir and Mariapun, Jeevitha and Ngim, Chin Fang and Dhanoa, Amreeta and Yeo, Tsin Wen (2022) A double whammy: The association between comorbidities and severe dengue among adult patients-A matched case-control study. PLoS ONE, 17 (9). ISSN 1932-6203, DOI https://doi.org/10.1371/journal.pone.0273071.

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Dengue infection is the most prevalent mosquito-borne viral infection globally. Concurrently, there has also been an upsurge of non-communicable comorbidities. We aimed to investigate the association between these comorbidities and the development of severe dengue. Methods We performed a retrospective, case-control study involving 117 cases with severe dengue and 351 controls with non-severe dengue; matched according to gender, age (+/- 5 years old), and admission date (+/- 2 weeks). We analyzed the data using conditional odds ratio (cOR) and adjusted conditional odds ratio (AcOR) using univariate and multivariable conditional logistic regression respectively. Results Six main comorbidities namely obesity, diabetes mellitus, hypertension, hyperlipidemia, chronic pulmonary disease, and ischemic heart disease were observed among cases and controls. Multivariable conditional logistic regression model found only hypertension to be independently associated with the development of severe dengue (ACOR 2.46; 95% CI:1.09-5.53). Among symptoms at presentation, lethargy, vomiting, bleeding manifestations, and abdominal pain were associated with increased odds of severe dengue, although the associations were not statistically significant. Headache (ACOR: 0:32; 95% CI: 0.21-0.51) and skin rash (ACOR: 0.42; 95% CI: 0.22-0.81) were associated with significantly lower odds of severe dengue. Severe dengue patients were also found to have significantly higher white cell count, urea, creatinine, alanine aminotransferase, aspartate aminotransferase, creatine kinase, and lactate dehydrogenase on admission, while platelet and albumin were significantly lower compared to non-severe dengue patients. Conclusions Our study found a significant association between hypertension and the development of severe dengue in adult patients. For clinical practice, this finding suggests that dengue patients with underlying hypertension warrant closer clinical monitoring for deterioration. The association between significant derangement in various laboratory parameters and severe dengue as shown in this study is in keeping with previous reports. While further substantiation by larger prospective studies will be desirable, this association may serve to inform the dengue triaging process.

Item Type: Article
Uncontrolled Keywords: Serum lactate-dehydrogenase; Acute kidney injury; Hemorrhagic-fever ; Shock syndrome
Subjects: R Medicine
Divisions: Faculty of Medicine
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 30 Aug 2023 07:13
Last Modified: 30 Aug 2023 07:13
URI: http://eprints.um.edu.my/id/eprint/41091

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