A Retrospective Study of Clinical Biomarkers of Severe Dengue in a Tertiary Hospital in Johor Bahru, Malaysia

TL;DR

This study analyzed clinical and lab features of severe dengue patients in Malaysia to identify patterns that could help predict ICU admission.

Contribution

The study identifies distinct clinical and laboratory biomarker profiles between ICU and non-ICU severe dengue patients.

Findings

ICU patients showed more plasma leakage signs and abnormal lab results like hypoalbuminemia and elevated creatine kinase.

Non-ICU patients were more likely to have leukopenia and normal levels of albumin, bilirubin, and creatine kinase.

Hyponatremia and elevated lactate dehydrogenase were common in both ICU and non-ICU groups.

Abstract

Management of severe dengue remains a clinical challenge. This retrospective study evaluated clinical features and laboratory biomarkers associated with severe dengue at Hospital Sultanah Aminah Johor Bahru from 1 January 2022 to 31 March 2023. Records of 99 patients, categorized into ICU (51) and non-ICU (48) groups, were identified and analyzed using SPSS version 28.0. Sociodemographic details, clinical features and laboratory biomarkers were collected. Patients aged 50 and older, those with obesity, and those with pre-existing comorbidities were significantly more likely to be admitted to the ICU. The four most common warning signs in both cohorts were lethargy/restlessness/confusion, abdominal pain, persistent vomiting, and diarrhea. Fever, or history of fever, and thrombocytopenia were the two most common severe dengue criteria present in both cohorts. ICU patients exhibited more signs of plasma leakage and abnormal laboratory findings, including normal white cell count, hypoalbuminemia, hyperbilirubinemia, and elevated creatine kinase. In contrast, leukopenia and normal albumin, bilirubin, and creatine kinase levels were more common in non-ICU patients. Hyponatremia and raised lactate dehydrogenase were seen in both groups. This study highlighted key differences and similarities in clinical features and laboratory biomarkers between ICU and non-ICU patients, emphasizing the need for further research to develop a comprehensive risk assessment tool for predicting severe dengue that resulted in ICU admission.