Clinical Spectrum, Severity Indicators, and Outcomes of Hospitalised Adults with Dengue: A Cross-Sectional Observational Study At A Tertiary Care Hospital

Abstract

Background: Dengue is the fastest growing vector borne viral disease in the world. Dengue is one of the highest burden diseases in the Southeast Asian region and hospitalised adult dengue is a wide spectrum disease ranging from febrile illness to severe dengue with plasma leakage, severe bleeding and organ failure. Predictors of progression to severity are important in terms of triage and resource allocation. Methods: The cross sectional observational study involved 350 hospitalised adults who were positive for NS1 antigen and/or IgM antibody of dengue (WHO 2009 classification) during one monsoon season in a tertiary care hospital. Clinical features, sequential laboratory parameters, and outcomes were recorded. Results: Warning signs: 41.1% and severe dengue: 12.3% occurred. Thrombocytopenia <20,000/µL occurred in 24.0%; AST >3× ULN in 28.3%; transfusion requirement in 9.1%; ICU admission in 14.3%; mortality 1.4%. AST >500 U/L, serum albumin <3 g/dL, age >45 years and presence of diabetes were independent multivariable predictors of severe dengue with aORs of 4.2, 3.6, 2.1, and 1.9, respectively. Conclusion: Dengue with warning signs and severe dengue affect a substantial proportion of hospitalised adults. Elevated AST and hypoalbuminaemia are strong independent severity predictors that can guide triage decisions. Judicious fluid management and vigilance for plasma leakage are cornerstones of effective clinical management.