The value of lung involvement in recognizing severe dengue-A retrospective study

Abstract

Background Dengue fever is a vector-borne disease transmitted by infected female Aedes mosquitoes. It has become the major threat to human beings especially in tropical and subtropical areas. It's important to find early parameters to identify severe dengue due to its poor prognosis. This study aimed to explore the value of lung involvement in identifying severe dengue (SD) from ordinary dengue.Methods 592 dengue patients admitted in the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to January 2020 were enrolled. Patients were divided into two groups, dengue with lung involvement group (DWLI) and dengue without lung involvement group (DWOLI). According to the severity of dengue fever, patients in DWLI group were further divided into dengue subgroup and SD subgroup. The clinical characteristics, treatment and outcome of the patients were analyzed between groups and subgroups respectively.Results The rate of SD patients was higher in DWLI group than that in DWOLI group. The ratios of old age, smoking, hepatobiliary disease, hypertension, diabetes, coronary heart disease and cerebrovascular disease were higher in DWLI group than those in DWOLI group (all p<0.05). Other organs such as liver, kidney, digestive tract were affected more in DWLI group (all p<0.05). Respiratory symptoms such as cough and breathlessness were more common in DWLI group (both p<0.05). Subgroup analyses showed that SD subgroup patients had more respiratory symptoms as well (p<0.05). Inflammatory markers including C-reactive protein (CRP) and pro-calcitonin (PCT) were increased in DWLI group (both p<0.05). The ratios of pleural effusion and bilateral lung infiltration were correlated with SD (both p<0.05). The ratios of anti-virus，anti-bacteria and combined therapy were higher in DWLI group. There were 10 cases in DWLI group complicated with multiple organ dysfunction syndrome (MODS) while no MODS occurred in DWOLI group. Except for 2 patients with MODS died, all the other patients were cured.Conclusions Among dengue fever patients, the elderly, smoking population, those accompanied by underlying diseases were prone to have lung involvement. Dengue fever patients who develop clinical manifestations such as cough, breathlessness, pleural effusion and bilateral pneumonic exudation should be warned of SD.