Dengue Myocarditis: A Retrospective Study From 2019 to 2023 in a Tertiary Care Hospital in Bangladesh

Abstract

Background A major global health problem is dengue illness, which is rising in Bangladesh between 2019 and 2023. Dengue infections can present with a wide range of symptoms, from fever to severe organ involvement like myocarditis. In this retrospective analysis, risk factors, clinic-laboratory profile, and outcomes of dengue myocarditis in hospitalised patients were investigated. Methods The study was a retrospective one, conducted in a tertiary private hospital in Dhaka between 2019 and 2023. Dengue infection was diagnosed by positive dengue nonstructural antigen (NS1) tests and/or dengue IgM or dengue RT-PCR (reverse transcription polymerase chain reaction) positivity. Dengue myocarditis was diagnosed with the European Society of Cardiology (ESC) 2013 consensus statement. For each myocarditis patient, we recruited age-, gender-, and year-of-admission-matched control dengue patients. Results Thirty-four dengue-myocarditis patients and 81 matched dengue patients were recruited as controls, with the mean age of myocarditis patients being 48.5 ± 20.1 years; 20.7% were from the 60-69 age group, and 21 (61.7%) were male. Mean (±standard deviation) leucocyte count 9.1 (±4.7) ×10⁹/L, alanine aminotransferase (ALT) 604 (±937) IU/L, aspartate aminotransferase (AST) 2076 (±4202) IU/L, and C-reactive protein (CRP) 5.5 (±5.3) mg/dL were significantly higher in the myocarditis group. Among 34 myocarditis patients, four patients (11.7%) died, with procalcitonin 18.8 (±27.5) ng/mL, prothrombin time (PT) 28.7 (±12.4) seconds, and activated partial thromboplastin time (APTT) 102.6 (±46.9) seconds being significantly higher. Multivariable logistic regression showed that the presence of comorbidities (odds ratio [OR]: 10.5; 95% confidence interval [CI]: 2.78-39.5]) and a raised neutrophil-lymphocyte ratio (NLR) (OR 11.9; 95% CI: 2.82-50.7) were significantly associated with myocarditis. Conclusion The presence of comorbidities and a higher NLR ratio were significantly associated with developing dengue myocarditis.

Keywords: bangladesh; clinical profile; dengue; mortality; myocarditis; risk factor.

Figure 1. STROBE flow diagram of patient inclusion, exclusion, and matching

ESC: European Society of Cardiology.

Figure 2. Forest plot of independent risk factors for myocarditis among hospitalised dengue patients

The forest plot displays the ORs and 95% CIs for clinical and laboratory variables associated with dengue-related myocarditis, derived from logistic regression analysis. The x-axis is plotted on a logarithmic scale to accurately reflect the multiplicative nature of ORs. The vertical dashed line represents the null effect (OR = 1.0). OR: odds ratio; CI: confidence interval; CRP: C-reactive protein; NLR: neutrophil-lymphocyte ratio; AST: aspartate aminotransferase.