Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Oct 9;10(1):123.
doi: 10.1186/s40249-021-00908-2.

Clinical predictors of severe dengue: a systematic review and meta-analysis

Tsheten Tsheten  1   2 , Archie C A Clements  3   4 , Darren J Gray  5 , Ripon K Adhikary  5 , Luis Furuya-Kanamori #  6 , Kinley Wangdi #  5
Affiliations
Meta-Analysis

Clinical predictors of severe dengue: a systematic review and meta-analysis

Tsheten Tsheten et al. Infect Dis Poverty. .

Abstract

Background: Severe dengue is a life-threatening complication; rapid identification of these cases, followed by adequate management is crucial to improve the clinical prognosis. Therefore, this study aimed to identify risk factors and predictors of severe dengue.

Methods: A literature search for studies reporting risk factors of severe dengue among individuals with dengue virus infection was conducted in PubMed, Scopus and Web of Science database from inception to December 31, 2020. Pooled odds ratios (ORs) for patients' demographic characteristics, co-morbidities, and warning signs were estimated using an inverse variance heterogeneity model.

Results: We included 143 articles in the meta-analysis from a total of 13 090 articles retrieved from the literature search. The risk factors of severe dengue were: being a child [OR = 1.96; 95% confidence interval (CI): 1.22-3.13], secondary infection (OR = 3.23; 95% CI: 2.28-4.57), and patients with pre-existing diabetes (OR = 2.88; 95% CI: 1.72-4.81) and renal disease (OR = 4.54; 95% CI: 1.55-13.31). Warning signs strongly associated with severe disease were increased haematocrit with a concurrent decrease in platelet count (OR = 5.13; 95% CI: 1.61-16.34), abdominal pain (OR = 2.00; 95% CI: 1.49-2.68), lethargy (OR = 2.73; 95% CI: 1.05-7.10), vomiting (OR = 1.80; 95% CI: 1.43-2.26), hepatomegaly (OR = 5.92; 95% CI: 3.29-10.66), ascites (OR = 6.30; 95% CI: 3.75-10.60), pleural effusion (OR = 5.72; 95% CI: 3.24-10.10) and melena (OR = 4.05; 95% CI: 1.64-10.00).

Conclusions: Our meta-analysis identified children, secondary infection, diabetes and renal disease(s) as important predictors of severe dengue. Our finding also supports the predictive ability of the WHO warning signs to identify severe dengue. These findings are useful for clinicians to identify severe dengue for management and timely interventions.

Keywords: Meta-analysis; Risk factor; Severe dengue; Warning sign.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Fig. 1
Fig. 1
Screening and selection of studies
See this image and copyright information in PMC

References

    1. Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, Drake JM, Brownstein JS, Hoen AG, Sankoh O, et al. The global distribution and burden of dengue. Nature. 2013;496:504–507. doi: 10.1038/nature12060. - DOI - PMC - PubMed
    1. Thomas SJ, Endy TP. Vaccines for the prevention of dengue: development update. Hum Vaccin. 2011;7:674–684. doi: 10.4161/hv.7.6.14985. - DOI - PubMed
    1. World Health Organization: Dengue and severe dengue. https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue. Accessed July 07 2021.
    1. Weaver SC, Vasilakis N. Molecular evolution of dengue viruses: contributions of phylogenetics to understanding the history and epidemiology of the preeminent arboviral disease. Infect Genet Evol. 2009;9:523–540. doi: 10.1016/j.meegid.2009.02.003. - DOI - PMC - PubMed
    1. World Health Organization. Dengue haemorrhagic fever: diagnosis, treatment, prevention and control. 2nd edition. Geneva 1997.