Published: 2021-03-26

The incidence and clinical profile of dengue hemorrhagic fever among patients diagnosed with dengue fever in a tertiary care centre in south India

Kiren George Koshy, Moothezhathu Kesavadas Suresh, Meenu Maheswari Suresh, Deepak Iype Koshy


Background: An understanding of factors predictive of severe forms of dengue fever would be helpful in risk stratification. The objective of the study was to determine incidence of and the factors associated with the development of dengue hemorrhagic fever (DHF) among patients admitted with dengue fever.

Methods: Consenting patients were consecutively enrolled in the study and were followed forward in time to establish if they had DHF rather than milder dengue. Several factors were studied to ascertain their relation to conversion to DHF.

Results: Cases included were 160 (103 males), with a mean age of 39.4 years (age range: 13-78). Fifty one (32%) developed DHF. On multivariate analysis; hepatomegaly, high alanine transaminase, low serum albumin and systolic blood pressure ≤100 mm Hg were independent predictors for the development of DHF.

Conclusions: Nearly a third of patients with dengue fever develop DHF. The predictors identified, should alert the physician to this impending complication.



Dengue fever, Dengue haemorrhagic fever, Hospital incidence, Risk factors

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World Health Organization (WHO). Dengue- Guidelines for Diagnosis, Treatment, Prevention and Control. New ed. Geneva, Switzerland: World Health Organization; 2009;1-147. Last accessed on 1st September, 2020.

Ganeshkumar P, Murhekar M V, Poornima V, Saravanakumar V, Sukumaran K, Anandaselvasankar A et. al. Dengue infection in India: a systematic review and meta-analysis Negl Trop Dis. 2018;12(7): e0006618.

Pongpan S, Wisitwong A, Tawichasri C, Patumanond J, Namwongprom S. Development of dengue infection severity score. ISRN Pediatr. 2013: 2013:1-6.

John K J, Gunasekharan K, Prasad JD, Mathew D, Das S, Sultan N Predictors of Major Bleeding and Mortality in Dengue Infection: A Retrospective Observational Study in a Tertiary Care Centre in South India. Interdiscip Perspect Infect Dis. 2018;2019:1-7.

Anker M, Arima Y. Male-female differences in the number of reported incident dengue fever cases in six Asian countries. Western Pac Surveill Response. 2011: 2(2):17-23.

Hasan SR, Riaz M, Jafri FA. Characteristics and outcome of dengue infection; clinical perspective from a secondary care hospital of Karachi. Pak J Med Sci. 2013;29(1):115-8.

Khan E, Kisat M, Khan N, Nasir A, Ayub S, Hasan R. Demographic and clinical features of dengue fever in Pakistan from 2003-2007: a retrospective cross-sectional study. PLoS One. 2010;5(9):e12505.

TH Mallhi, AH Khan, AS Adnan, Sarriff A, Khan Y H, Jummaat F. Clinico-laboratory spectrum of dengue viral infection and risk factors associated with dengue hemorrhagic fever: a retrospective study. BMC Infect Dis. 2015;15:399-410.

Kumar A, Rao CR, Pandit V, Shetty S, Bammigatti C, Samarasinghe CM. Clinical manifestations and trend of dengue cases admitted in a tertiary care hospital, Udupi district, Karnataka. Indian J Community Med. 2010;35(3):386-90.

Yung CF, Lee KS, Thein TL, Tan LK, Gan VC, Wong JGX et al. Dengue Serotype-Specific Differences in Clinical Manifestation, Laboratory Parameters and Risk of Severe Disease in Adults, Singapore. Am J Trop Med Hyg. 2015;92(5):999-1005.

Bravo L, Roque VG, Brett J, Dizon R, L’Azou M. Epidemiology of Dengue Disease in the Philippines (2000–2011): A Systematic Literature Review. PLoS Negl Trop Dis. 2014;8(11):e3027.

Tee HP, How SH, Jamalludin AR, Safhan MN, Sapian MM, Kuan YC. Risk factors associated with development of dengue haemorrhagic fever or dengue shock syndrome in adults in hospital Tengku Ampuan Afzan Kuantan. Med J. Malaysia. 2009;64:316-320.

Vasanwala FF, Thein TL, Leo YS, Gan VC, Hao Y, Lee LK et al. Predictive Value of Proteinuria in Adult Dengue Severity. Guzman MG, ed. PLoS Negl Trop Dis. 2014;8(2):e2712.

Sreenivasan P, SG, KS. Development of a Prognostic Prediction Model to Determine Severe Dengue in Children. Indian J Pediatr. 2018;85:433-9.

Wahid SF, Sanusi S, Zawawi MM, Ali RA. A comparison of the pattern of liver involvement in dengue hemorrhagic fever with classic dengue fever. Southeast Asian J Trop Med Public Health. 2000;31(2):259-63.

Lee LK, Gan VC, Lee VJ, Tan AS, Leo YS, Lye DC. Clinical relevance and discriminatory value of elevated liver aminotransferase levels for dengue severity. PLoS Negl Trop Dis. 2012;6(6):e1676.

Ahmed S, Mohammad WW, Hamid F, Akhter A, Afzal RK, Mahmood A. The 2011 Dengue Haemorrhagic Fever Outbreak in Lahore - An Account of Clinical Parameters and Pattern of Haemorrhagic Complications. J Coll Physicians Surg Pak. 2013;23(7):463-7.

Biswas HH, Gordon A, Nuñez A, Perez MA, Balmaswda A, Harris E. Lower Low-Density Lipoprotein Cholesterol Levels Are Associated with Severe Dengue Outcome. PLoS Negl Trop Dis. 2015;9(9):e0003904.

Martin-Acebes MA, Vazquez-Calvo A, Saiz JC. Lipids and flaviviruses, present and future perspectives for the control of dengue, Zika, and West Nile viruses. Prog. Lipid Res. 2016;64:123-37.