Prevalence of heart failure in dengue patients with concurrent capillary leakage syndrome, unveiling ‘leakage-failure coexistence’

Mohammad Abdul Motalib; Dipok Kumar Pramanik

doi:10.18203/2320-6012.ijrms20250237

Authors

Mohammad Abdul Motalib Department of Internal Medicine Khwaja Yunus Ali Medical College & Hospital, Sirajganj, Bangladesh
Dipok Kumar Pramanik Department of Internal Medicine Khwaja Yunus Ali Medical College & Hospital, Sirajganj, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20250237

Keywords:

Prevalence, Heart failure, Dengue patients, Concurrent capillary leakage syndrome

Abstract

Background: Dengue fever, a mosquito-borne viral infection, has been a growing global health concern with significant morbidity and mortality. Among the myriad complications that Dengue can manifest, capillary leakage syndrome has emerged as a particularly severe and challenging aspect of the disease.

Aim of the study: The aim of this study was to assess the prevalence of heart failure in dengue patients with concurrent capillary leakage syndrome.

Methods: This cross-sectional observational study was conducted in Department of Medicine, Khwaja Yunus Ali Medical Hospital, Sirajgonj, Bangladesh, during the period from July 2022 to June 2024. Out of 400 cases of dengue fever patients, 50 patients diagnosed with dengue fever with heart failure with concurrent capillary leakage syndrome were included in this study.

Result: This study of total 400 participants (mean age 35.4±12.6 years) revealed male predominance (64%, p=0.036) and urban residency (76%, p=0.017). The average presentation delay was 6.2 days, with 30% reporting prior dengue (p=0.025). Laboratory findings showed elevated hematocrit (48.5%±5.2%, p=0.012), hypoalbuminemia (1.8±0.4 g/dl, p=0.001), and raised NT-proBNP (1500 pg/ml, p=0.007), indicating CLS and cardiac stress. Echocardiography identified reduced LVEF (28%), myocarditis (22%), and arrhythmias (16%) on ECG. Predictors of heart failure included NT-proBNP (OR 4.2, p=0.002) and hypoalbuminemia (OR 3.5, p=0.004). Heart failure was present in 5%, highlighting the burden of CLS and cardiac dysfunction, necessitating improved diagnostics and multidisciplinary interventions.

Conclusion: This study highlights the multifaceted complications of CLS and cardiac involvement in dengue patients.

Metrics

Metrics Loading ...

References

Dhar-Chowdhury P, Paul KK, Haque CE, Lindsay LR, Dibernardo A, Paploski IA, et al. Dengue seroprevalence, seroconversion and risk factors in Dhaka, Bangladesh. PLoS Negl Trop Dis. 2017;11(3):5475. DOI: https://doi.org/10.1371/journal.pntd.0005475

Yesmin S, Rahman MS, Haque A, Sarker SK. Clinical profile of pediatric cases of dengue during the 2019 epidemic in Bangladesh. Int J Pediatr. 2023;2:1–10. DOI: https://doi.org/10.47211/tg.2023.v10i04.001

Rafi MA, Rahman MR, Rahman S, Alam S, Rumi RA, Hossain MJ. Dengue epidemic in a non-endemic zone of Bangladesh: Clinical and laboratory profiles of patients. Trop Med Infect Dis. 2020;5(4):197. DOI: https://doi.org/10.1101/2020.06.08.20126094

Islam S, Nazmul Islam M, Hossain MS, Yesmin S, Ahmed Z, Hossain MA. Clinical profile, severity spectrum, and hospital outcome of dengue patients in a tertiary care hospital in Dhaka city. Int J Infect Dis. 2022;118:147–53. DOI: https://doi.org/10.7759/cureus.28843

Her Z, Kam YW, Lin RT, Ng LF. Severity of plasma leakage is associated with high levels of interferon γ-inducible protein 10, hepatocyte growth factor, and matrix metalloproteinases during dengue virus infection. J Infect Dis. 2017;215(1):42–51. DOI: https://doi.org/10.1093/infdis/jiw494

Avirutnan P, Fuchs A, Hauhart RE, Somnuke P, Youn S, Diamond MS, et al. Vascular leakage in severe dengue virus infections: a potential role for the nonstructural viral protein NS1 and complement. J Infect Dis. 2006;193(8):1078–88. DOI: https://doi.org/10.1086/500949

McDonald DM, Thurston G. Endothelial gaps as sites for plasma leakage in inflammation. Microcirculation. 1999;6(1):7–22. DOI: https://doi.org/10.1080/713773924

Cristodulo J, Kanagarajah J, Gopalan H. Dengue myocarditis: A case report and major review. J Clin Cardiol. 2023;2(3):11–20. DOI: https://doi.org/10.5334/gh.1254

Miranda CH, Borges MDC, Schmidt A, Pazin-Filho A, Rossi MA, Ramos SG, et al. Evaluation of cardiac involvement during dengue viral infection. Clin Infect Dis. 2013;57(8):1126–33. DOI: https://doi.org/10.1093/cid/cit403

Nerella N, Kamath S, Kamath P. Electrocardiographic and echocardiographic findings in children with dengue infection. Int J Pediatr. 2022;2022:8854067. DOI: https://doi.org/10.4103/jfmpc.jfmpc_1280_21

Baqi A, Hashmi B, Ahmed F, Abbas S. Prevalence and outcomes of myocarditis in dengue-infected patients admitted to a tertiary care hospital. Cureus. 2022;14(1):e21004. DOI: https://doi.org/10.5334/gh.1129

Druey KM, Greipp PR. Narrative review: the systemic capillary leak syndrome. Ann Intern Med. 2010;153(2):90–8. DOI: https://doi.org/10.7326/0003-4819-153-2-201007200-00005

Sarker AR, Sultana M, Mahumud RA, Van Minh H, Sheikh N, Morton A. Economic burden of dengue in urban Bangladesh: A societal perspective. BMC Public Health. 2023;23(1):105.

Dhar-Chowdhury P, Haque CE, Lindsay LR, Dibernardo A, Paul KK, Alam SM. Dengue disease risk mental models in the city of Dhaka, Bangladesh. Trop Med Int Health. 2016;21(9):1090–9.

Juthier F, Labbé S, Tamarelle P, Vancassel P, Cochet C, Juthier F, et al. Myocardial involvement in systemic capillary leak syndrome: first demonstration by pathologic findings. Hum Pathol. 2012;43(3):453–8. DOI: https://doi.org/10.1177/2048872612455142

Ertel A, Peerless M, Myerson SG, Taylor AM. Increased myocardial extracellular volume in active idiopathic systemic capillary leak syndrome. J Cardiovasc Magn Reson. 2015;17(S1):168. DOI: https://doi.org/10.1186/s12968-015-0181-6

Prattay KMR, Haider MM, Hossain ME, Tanjil MR, Bhuyan SK. A retrospective study on the socio-demographic factors and clinical parameters of dengue disease. J Clin Microbiol Infect Dis. 2022;41(5):1052–8.

Nguyen TP, Truong H, Nguyen VH, Nguyen NM. Associations of obesity and dengue-associated mortality, acute liver failure, and mechanical ventilation in children with dengue shock syndrome. PLoS Negl Trop Dis. 2023;17(5):e0010746.

Bhattacharjee T, Dasgupta S, Gupta D, Roy S. Evaluation of cardiac biomarkers in dengue myocarditis in a tertiary care hospital in Eastern India. J Clin Diagn Res. 2020;14(5):OC09–OC12. DOI: https://doi.org/10.7860/JCDR/2020/46354.14377

Mohammed S, Atherton JJ, Gersh BJ. Hyponatremia, natriuretic peptides, and outcomes in acutely decompensated heart failure. J Am Coll Cardiol. 2010;56(7):577–85. DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.109.915280

Yacoub S, Griffiths A, Aikawa N, Jawad A, Martinez F, Mukhopadhyay S. Cardiac function in Vietnamese patients with different dengue severity grades. Crit Care Med. 2012;40(3):477–84. DOI: https://doi.org/10.1097/CCM.0b013e318232d966

Soneja M, Juneja D, Singh O, Sinha S, Goel S. Myocarditis in dengue: a prospective observational study. Trop Med Int Health. 2019;24(8):917–23.

Kang S, Wu L, Du M, Shi R. Prognostic value of NT-proBNP in heart failure with preserved versus reduced ejection fraction. Heart. 2015;101(21):1753–60. DOI: https://doi.org/10.1136/heartjnl-2015-307782

Meltzer E, Schwartz E. Capillary leakage in travelers with dengue infection: implications for pathogenesis. J Travel Med. 2012;19(3):153–8. DOI: https://doi.org/10.4269/ajtmh.2012.10-0670

Nguyen LT, Do TN, Phan HP, Vo VT, Hoang TM. Clinical features and management of children with dengue-associated obstructive shock syndrome. Trop Med Int Health. 2022;27(1):90–8. DOI: https://doi.org/10.1097/MD.0000000000031322