Abstract
BackgroundA pattern of both clinical and biochemical abnormalities is associated with dengue virus infection (DVI). Among the various DVI-related biochemical defects, electrolyte imbalance is one that can alter the morbidity and mortality among patients. However, there is a dearth of evidence to assess the relationship between electrolyte imbalance and the length of stay or mortality in dengue-infected patients in Pakistan. In the current study, we aimed to investigate the association between electrolyte imbalance at the time of admission and the length of stay and mortality among dengue-infected patients.MethodsWe conducted a retrospective study at a large tertiary care hospital from November 2018 to November 2019. All patients with known chronic diseases and coinfections or those who were taking diuretics therapies or angiotensin-converting enzyme inhibitors were excluded. Our main exposure of interest was electrolytes imbalance and the outcome measure was the length of stay and mortality.ResultsA total of 1,008 dengue patients were enrolled with a mean length of stay of 2.56 days. Around 29.3% had hyponatremia and 23.2% had hypokalemia at the time of admission, and 21.9% of patients had a stay beyond three days. In multivariable analysis, hyponatremia [adjusted odds ratios (aOR) = 1.29; 95% confidence interval (CI): 0.59-2.84] and hypokalemia (aOR = 2.36; 95% CI: 0.91-6.10) were not found to be associated with the length of stay. However, patients with high troponin levels at admission had a prolonged stay beyond three days (aOR = 5.74; 95% CI: 2.34-14.11). There was a statistically significant association of creatinine levels (aOR = 14.74; 95% CI: 4.19-15.85) and diabetes mellitus (DM) (aOR = 4.36; 95% CI: 1.21-15.74) with mortality after controlling for potential confounders.ConclusionElectrolyte imbalance at admission is not a predictor of length of stay or fatalities in the hospital among patients with DVI. However, troponin levels at admission can increase hospitalization days whereas DM and renal injury have been found to worsen mortality rates.
Highlights
The considerable surge in dengue virus infections (DVI) in recent years has made it the most swiftly spreading arthropod-borne viral disease caused by one of the four serotypes of dengue viruses from the Flaviviridae family
Hyponatremia [adjusted odds ratios = 1.29; 95% confidence interval (CI): 0.59-2.84] and hypokalemia were not found to be associated with the length of stay
There was a statistically significant association of creatinine levels and diabetes mellitus (DM) with mortality after controlling for potential confounders
Summary
The considerable surge in dengue virus infections (DVI) in recent years has made it the most swiftly spreading arthropod-borne viral disease caused by one of the four serotypes of dengue viruses from the Flaviviridae family. Pakistan has been considered dengue-endemic since 1994, and the disease has become a public health problem since 2006, resulting in around 147,200 cases and over 800 deaths from 1995 to 2019 [5]. Among the various DVI-related biochemical defects, electrolyte imbalance is one that can alter the morbidity and mortality among patients. There is a dearth of evidence to assess the relationship between electrolyte imbalance and the length of stay or mortality in dengue-infected patients in Pakistan. We aimed to investigate the association between electrolyte imbalance at the time of admission and the length of stay and mortality among dengue-infected patients
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