Clinical predictors of severe dengue: a systematic review and meta-analysis

Abstract

Background Severe dengue is a life-threatening complication; rapid identification of these cases, followed by adequate management is crucial to improve the clinical prognosis. Therefore, this study aimed to identify risk factors and predictors of severe dengue. Methods A literature search for studies reporting risk factors of severe dengue among individuals with dengue virus infection was conducted in PubMed, Scopus and Web of Science database from inception to December 31, 2020. Pooled odds ratios (ORs) for patients’ demographic characteristics, co-morbidities, and warning signs were estimated using an inverse variance heterogeneity model. Results We included 143 articles in the meta-analysis from a total of 13 090 articles retrieved from the literature search. The risk factors of severe dengue were: being a child [OR = 1.96; 95% confidence interval (CI): 1.22–3.13], secondary infection (OR = 3.23; 95% CI: 2.28–4.57), and patients with pre-existing diabetes (OR = 2.88; 95% CI: 1.72–4.81) and renal disease (OR = 4.54; 95% CI: 1.55–13.31). Warning signs strongly associated with severe disease were increased haematocrit with a concurrent decrease in platelet count (OR = 5.13; 95% CI: 1.61–16.34), abdominal pain (OR = 2.00; 95% CI: 1.49–2.68), lethargy (OR = 2.73; 95% CI: 1.05–7.10), vomiting (OR = 1.80; 95% CI: 1.43–2.26), hepatomegaly (OR = 5.92; 95% CI: 3.29–10.66), ascites (OR = 6.30; 95% CI: 3.75–10.60), pleural effusion (OR = 5.72; 95% CI: 3.24–10.10) and melena (OR = 4.05; 95% CI: 1.64–10.00). Conclusions Our meta-analysis identified children, secondary infection, diabetes and renal disease(s) as important predictors of severe dengue. Our finding also supports the predictive ability of the WHO warning signs to identify severe dengue. These findings are useful for clinicians to identify severe dengue for management and timely interventions.

Does dengue and COVID‐19 co‐infection have worse outcomes? A systematic review of current evidence

“…[38][39][40] Many previous studies also showed that among patients with severe dengue infection, up to 55.9% suffered from a concurrent bacterial infection. 23,26 Dengue infection might also lead to serious morbidities such as dengue syndrome and dengue haemorrhagic fever, [41][42][43][44][45][46] contributing to the estimated high rates of mortality and ICU admissions in the current study.…”

Serum biomarkers and anti-flavivirus antibodies at presentation as indicators of severe dengue

“…Adults are more likely to develop severe bleeding, and this may be more difficult to manage than plasma leakage, for which judicious fluid replacement is often effective [3, 6, 8, 17, 23, 24, 46]. Comorbid illness, including poorly-controlled diabetes mellitus (hemoglobin A1c >7%) and renal disease, have been associated with SD [16, 18], and hypertension has also been identified in certain studies [18]. A gender difference among clinically severe dengue has varied across studies [1, 6, 13, 17, 18].…”

“…Comorbid illness, including poorly-controlled diabetes mellitus (hemoglobin A1c >7%) and renal disease, have been associated with SD [16, 18], and hypertension has also been identified in certain studies [18]. A gender difference among clinically severe dengue has varied across studies [1, 6, 13, 17, 18]. In our population, 66.4% of DWS-/DWS+ cases were female in comparison to only 26.1% of SD cases, and this difference remained significant after controlling for age and comorbidities.…”

Dengue and COVID-19: two sides of the same coin

“…Therefore, currently more severe forms of dengue (DHF/DSS) are predominantly seen in the older population in some countries, where CFRs tend to be higher than in younger individuals [ 79 , 83 ]. However, some studies have shown that CFRs are higher in children, and these differences possibly reflect the differences in disease epidemiology in different countries [ 119 ]. Men were significantly more likely to have severe illness in COVID-19, whereas no such associations have been seen with dengue [ 39 , 60 ].…”