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Meta-Analysis
. 2024 May 31;18(5):e0012217.
doi: 10.1371/journal.pntd.0012217. eCollection 2024 May.

Diabetes mellitus as a risk factor for severe dengue fever and West Nile fever: A meta-analysis

Hong-Zheng Lu  1   2 , Yu-Zhuang Xie  1 , Chen Gao  1   2 , Ying Wang  3 , Ting-Ting Liu  3 , Xing-Zhe Wu  4 , Fang Dai  4 , Duo-Quan Wang  5 , Sheng-Qun Deng  1
Affiliations
Meta-Analysis

Diabetes mellitus as a risk factor for severe dengue fever and West Nile fever: A meta-analysis

Hong-Zheng Lu et al. PLoS Negl Trop Dis. .

Abstract

Background: Dengue fever (DF) and West Nile fever (WNF) have become endemic worldwide in the last two decades. Studies suggest that individuals with diabetes mellitus (DM) are at a higher risk of developing severe complications from these diseases. Identifying the factors associated with a severe clinical presentation is crucial, as prompt treatment is essential to prevent complications and fatalities. This article aims to summarize and assess the published evidence regarding the link between DM and the risk of severe clinical manifestations in cases of DF and WNF.

Methodology/principal findings: A systematic search was conducted using the PubMed and Web of Science databases. 27 studies (19 on DF, 8 on WNF) involving 342,873 laboratory-confirmed patients were included in the analysis. The analysis showed that a diagnosis of DM was associated with an increased risk for severe clinical presentations of both DF (OR 3.39; 95% CI: 2.46, 4.68) and WNF (OR 2.89; 95% CI: 1.89, 4.41). DM also significantly increased the risk of death from both diseases (DF: OR 1.95; 95% CI: 1.09, 3.52; WNF: OR 1.74; 95% CI: 1.40, 2.17).

Conclusions/significance: This study provides strong evidence supporting the association between DM and an increased risk of severe clinical manifestations in cases of DF and WNF. Diabetic individuals in DF or WNF endemic areas should be closely monitored when presenting with febrile symptoms due to their higher susceptibility to severe disease. Early detection and appropriate management strategies are crucial in reducing the morbidity and mortality rates associated with DF and WNF in diabetic patients. Tailored care and targeted public health interventions are needed to address this at-risk population. Further research is required to understand the underlying mechanisms and develop effective preventive and therapeutic approaches.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of publication selection process.
Fig 2
Fig 2. Forest plot of dengue.
The size of the black square corresponding to each study is proportional to the sample size, and the center of each square represents the OR. Horizontal line shows the corresponding 95% CI of the OR. Pooled OR is represented by hollow diamond.
Fig 3
Fig 3. Forest plot of West Nile fever.
The size of the black square corresponding to each study is proportional to the sample size, and the center of each square represents the OR. Horizontal line shows the corresponding 95% CI of the OR. Pooled OR is represented by hollow diamond.
Fig 4
Fig 4. Forest plot of dengue disease process according to the 1997 WHO criteria.
Forest plot of denguehemorrhagic fever (A). Forest plot of dengue shock syndrome (B). The size of the black square corresponding to each study is proportional to the sample size, and the center of each square represents the OR. Horizontal line shows the corresponding 95% CI of the OR. Pooled OR is represented by hollow diamond.
Fig 5
Fig 5. Forest plot of severe West Nile fever with different manifestations.
Forest plot of West Nile meningitis (A). Forest plot of West Nile encephawlitis (B). Forest plot of West Nile virus-associated retinopathy (C). The size of the black square corresponding to each study is proportional to the sample size, and the center of each square represents the OR. Horizontal line shows the corresponding 95% CI of the OR. Pooled OR is represented by hollow diamond.
Fig 6
Fig 6. Forest plot of death.
Forest plot of diabetes mellitus on death of dengu (A). Forest plot of diabetes mellitus on death of West Nile fever (B). The size of the black square corresponding to each study is proportional to the sample size, and the center of each square represents the OR. Horizontal line shows the corresponding 95% CI of the OR. Pooled OR is represented by hollow diamond.
See this image and copyright information in PMC

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