Abstract
BackgroundDengue hemorrhagic fever (DHF) is a severe form of dengue, characterized by bleeding and plasma leakage. A number of DHF risk factors had been suggested. However, these risk factors may not be generalized to all populations and epidemics for screening and clinical management of patients at risk of developing DHF. This study explored demographic and comorbidity risk factors for DHF in adult dengue epidemics in Singapore in year 2006 (predominantly serotype 1) and in year 2007–2008 (predominantly serotype 2).MethodsA retrospective case-control study was conducted with 149 DHF and 326 dengue fever (DF) patients from year 2006, and 669 DHF and 1,141 DF patients from year 2007–2008. Demographic and reported comorbidity data were collected from patients previously. We performed multivariate logistic regression to assess the association between DHF and demographic and co-morbidities for year 2006 and year 2007–2008, respectively.ResultsOnly Chinese (adjusted odds ratio [AOR] = 1.90; 95% confidence interval [CI]: 1.01–3.56) was independently associated with DHF in year 2006. In contrast, age groups of 30–39 years (AOR = 1.41; 95% CI:1.09–1.81), 40–49 years (AOR = 1.34; 95% CI:1.09–1.81), female (AOR = 1.57; 95% CI:1.28–1.94), Chinese (AOR = 1.67; 95% CI:1.24–2.24), diabetes (AOR = 1.78; 95% CI:1.06–2.97), and diabetes with hypertension (AOR = 2.16; 95%CI:1.18–3.96) were independently associated with DHF in year 2007–2008. Hypertension was proposed to have effect modification on the risk of DHF outcome in dengue patients with diabetes. Chinese who had diabetes with hypertension had 2.1 (95% CI:1.07–4.12) times higher risk of DHF compared with Chinese who had no diabetes and no hypertension.ConclusionsAdult dengue patients in Singapore who were 30–49 years, Chinese, female, had diabetes or diabetes with hypertension were at greater risk of developing DHF during epidemic of predominantly serotype 2. These risk factors can be used to guide triaging of patients who require closer clinical monitoring and early hospitalization in Singapore, when confirmed in more studies.
Highlights
Dengue is a major neglected tropical disease in the tropical and subtropical regions of the world [1]. It is predominantly found in urban and semi-urban areas, and results in a wide spectrum of clinical manifestations, from asymptomatic infection, undifferentiated fever, dengue fever (DF) to severe infection known as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) [2]
In the subgroup analysis of 1,220 (67.4%) patients hospitalized during the year 2007–2008 that had dengue IgG data, we further showed that diabetes (AOR: 1.92; 95% confidence intervals (CI): 1.02–3.61) as well as diabetes with hypertension (AOR: 4.41; 95% CI: 1.16–16.82) remained as risk factor of DHF (Table S1)
The results of this study showed that female, Chinese, age group between 30 to 49 years, pre-existing diabetes mellitus or diabetes mellitus with hypertension were risk factors of developing DHF during the year 2007 and 2008 epidemic when dengue serotype 2 was predominant
Summary
Dengue is a major neglected tropical disease in the tropical and subtropical regions of the world [1] It is predominantly found in urban and semi-urban areas, and results in a wide spectrum of clinical manifestations, from asymptomatic infection, undifferentiated fever, dengue fever (DF) to severe infection known as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) [2]. It is estimated about 50 million infections occur annually, with 500,000 DHF cases and 22,000 deaths [3]. This study explored demographic and comorbidity risk factors for DHF in adult dengue epidemics in Singapore in year 2006 (predominantly serotype 1) and in year 2007–2008 (predominantly serotype 2)
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