Risks of Acute Cholecystitis, Acute Pancreatitis, and Acute Appendicitis in Patients with Dengue Fever: A Population-Based Cohort Study in Taiwan

Abstract

Introduction Although cases of acute cholecystitis, acute pancreatitis, and acute appendicitis following dengue virus infections have been documented, very few large-scale studies have investigated the postdengue risk of these acute abdominal conditions. Methods This retrospective population-based cohort study included all patients with laboratory-confirmed dengue from 2002 to 2015 in Taiwan and 1:4 nondengue individuals matched by age, sex, area of residence, and symptom onset time. Multivariate Cox proportional hazards regression models were used to investigate the short-term (≤ 30 days), medium-term (31–365 days), and long-term (> 1 year) risks of acute cholecystitis, pancreatitis, and appendicitis after dengue infection, adjusted for age, sex, area of residence, urbanization level, monthly income level, and comorbidities. Bonferroni correction was used for multiple testing; E-values were used to assess the robustness of the results to unmeasured confounding. Results This study included 65,694 individuals with dengue and 262,776 individuals without dengue. Patients with dengue had a significantly increased risk of acute cholecystitis (adjusted hazard ratio (aHR) 60.21; 95% CI 29.11–124.54; P < 0.0001, E-value = 119.92) and acute pancreatitis (aHR 17.13; 95% CI 7.66–38.29; P < 0.0001, E-value = 33.75) within the first 30 days postinfection compared to those without dengue, but this increased risk was not present after that. The incidence rates of acute cholecystitis and pancreatitis in the first 30 days were 18.79 and 5.27 per 10,000, respectively. No increased risk of acute appendicitis was observed among patients with acute dengue infection. Conclusion This study was the first large epidemiological study to show a significantly increased risk of acute cholecystitis and pancreatitis among patients with dengue during the acute phase of dengue infection, while no such association was observed for acute appendicitis. Early identification of acute cholecystitis and pancreatitis in patients with dengue is crucial for preventing fatal complications. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-023-00821-1.

Dengue fever presenting with acute pancreatitis: A case report

“… 9 A cohort study conducted in Taiwan found a significantly increased risk of acute pancreatitis in dengue patients in the first month after infection. 10 A systematic review studying 9,365 dengue patients found that 16% of the patients presented with acute abdomen; 7.7% of which were attributed to acute pancreatitis. 11 This goes on to signify the importance of recognizing dengue virus as an important cause of acute pancreatitis in areas like ours where the infection is widespread.…”

“…Abdominal pain can be present in around 40% of the patients with dengue fever and could result from either hepatitis, acalculous cholecystitis, acute pancreatitis, or inflammation of the colon itself. 7 , 10 Acute pancreatitis is an atypical and rare presentation of dengue fever, with limited literature, mostly in the form of isolated case reports from across the world. 11 It has also been suggested that in case etiology of pancreatitis is not clear in the presence of fever and thrombocytopenia, working up for dengue can be helpful even if the fever has subsided.…”