Clinical and haematological correlates of severe dengue using 2023 epidemic data: A multicentre tertiary hospital-based analysis from Dhaka, Bangladesh.

BACKGROUND

Dengue fever, caused by the dengue virus (DENV), remains a major public health threat in tropical and subtropical regions. Bangladesh recoded its largest dengue outbreak in 2023. Understanding factors associated with dengue severity is essential to improve clinical triage and outcome.

METHODS

We conducted a hospital-based study of 466 laboratory-confirmed dengue cases admitted to four tertiary hospitals in Dhaka during the peak epidemic period (September 1 to October 31, 2023). Demographic, clinical, and laboratory data were collected using a semi-structured questionnaire. Cases were categorized based on severity, and multivariable models were used to identify factors associated with severe dengue.

RESULTS

Severe dengue was independently associated with older age (adjusted OR [aOR] 2.381, 95% confidence interval [CI] 2.378-2.385) and higher pulse rate (aOR 1.035, 95% CI 1.034-1.037). After adjustment, higher BMI showed a protective association with severe dengue (aOR 0.094, 95% CI 0.094-0.094,). Higher platelet count (aOR 0.834, 95% CI 0.832-0.835), hematocrit (aOR 0.010, 95% CI 0.010-0.010), white blood cell (WBC) count (aOR 0.594, 95% CI 0.593-0.595), and body temperature (aOR 0.543, 95% CI 0.542-0.544) were also associated with reduced odds of severe outcomes. Delays in seeking care were associated with increased severity (p = 0.007). Symptom-based markers, such as abdominal pain (p < 0.001) and respiratory distress (p = 0.013), were strong predictors of severe dengue.

CONCLUSIONS

Risk of severe dengue was driven by demographic and clinical features, and was exacerbated by delayed presentation. The observed association involving BMI warrants further study. These findings may support targeted, timely clinical management during outbreaks.