Outcomes of adult severe dengue in a tertiary care centre of Bangladesh: a cross-sectional retrospective observation

With an alarmingly high case fatality rate (CFR) of 0.56% in 2024, marking the consecutive year to report its devastating outbreak on record in 2023 with 1,705 fatalities, dengue fever presents a major public health challenge in Bangladesh, with seasonal outbreaks causing morbidity, mortality, and strain on the healthcare system. Understanding the factors influencing disease severity and outcomes is crucial for improving clinical management and reducing the disease burden. This retrospective observational study aimed to identify clinical patterns, risk factors, complications, and outcomes among adult severe dengue patients admitted to BIRDEM General Hospital, Dhaka, Bangladesh. Hospital records of admitted patients were analyzed to find the prevalence of severe dengue and explore the potential risk factors contributing to the severity of dengue outcomes. Key parameters included patient demographics, comorbidities, clinical manifestations, laboratory findings, and treatment outcomes. This retrospective study analyzed 330 adult dengue fever cases, identifying 26 (7.9%) as severe dengue. Severe dengue patients were significantly older (mean ~ 59 years), and showed a higher occurrence in pre-existing diabetes (84.6%), hypertension (69.2%), and chronic kidney disease (26.9%). Alteration of consciousness was significantly associated with severity, enhancing the odds of progressing to severe dengue by 51 times. Laboratory findings included significantly lower mean hematocrit (32.86%), hemoglobin (11.02 mg/dl), elevated liver enzymes (mean ALT 467.79 U/L, AST 865.3 U/L, ALP 146.41 U/L), lower serum albumin (31.7 mg/dL), elevated BUN (61.68 mg/dL), creatinine (2.71 mg/dL), and LDH (3007.33 U/L). A logistic regression model demonstrated good predictive ability (AUC = 0.8302), with alteration of consciousness and higher AST as independent risk factors of severe dengue. Based on the available data, despite high rates of complications (81% including plasma leakage, organ impairment, and concurrent co-infections), 16 (62%) were cured, and minimal mortality was reported (n = 3). By identifying high-risk populations and predictors of severe outcomes, this research aims to improve patient care and reduce dengue-related mortality.