Prevalence and factors associated with cardiac involvement in hospitalized patients with dengue: a cross-sectional study

BACKGROUND: Cardiac involvement is an underrecognized but potentially life-threatening complication of dengue fever. We aimed to estimate the prevalence and identify predictors of cardiac involvement among hospitalized patients with dengue. METHODS: We conducted a cross-sectional study including 919 patients with confirmed dengue. Cardiac involvement was defined based on clinical features (e. g. chest pain, dyspnoea, syncope), electrocardiogram (ECG) changes, elevated cardiac biomarkers (high-sensitivity troponin I hs-troponin I or N-terminal pro-hormone of brain natriuretic peptide) or echocardiographic abnormalities. We performed multivariable logistic regression to identify independent predictors and developed a classification and regression tree (CART) model for risk stratification. RESULTS: Overall, 14% of patients had cardiac involvement such as pericardial effusion (26%), elevated hs-troponin I (38%) and ECG abnormalities (10%). Significant associated factors were age >60 y (adjusted odds ratio aOR 3. 05 95% confidence interval CI 1. 53 to 6. 08), warning signs (aOR 2. 77 95% CI 1. 76 to 4. 37), anaemia (aOR 1. 84 95% CI 1. 16 to 2. 95), thrombocytopenia (aOR 1. 82 95% CI 1. 09 to 3. 11), elevated serum creatinine (aOR 2. 20 95% CI 1. 34 to 3. 60), hypoalbuminaemia (aOR 3. 06 95% CI 1. 74 to 5. 57) and elevated D-dimer levels (aOR 5. 90 95% CI 3. 67 to 9. 54). The CART model identified age, warning signs, D-dimer and platelet count as significant predictors. CONCLUSIONS: Cardiac complications are common in dengue and should be considered in the management of high-risk patients.