Clinical, Hematological, Biochemical And Serotype Correlates Of Disease Severity In Hospitalized Dengue Patients: A Cross-Sectional Study Of 100 Patients

Abstract

Background: Dengue infection exhibits a broad clinical spectrum, and early recognition of patients at risk of severe disease remains important. This study evaluated the relationship of routine hematological and biochemical parameters with clinical manifestations, described dengue virus serotype distribution, and examined associations between serotype patterns and disease severity in hospitalized patients.

Materials and methods: The study was conducted in Department of Microbiology of Jaipur National University Instruction of Medical Science and Research Center, Jaipur, Rajasthan. This study included 100 patients aged >11 years with laboratory confirmed dengue and platelet counts below 100,000/µL. Demographic, clinical, hematological, biochemical, serological, molecular serotype were analyzed. Severe and non-severe dengue were compared using non-parametric tests for continuous variables and chi-square/Fisher's exact tests for categorical variables. Spearman rank correlation was used for exploratory assessment of laboratory parameters and clinical-manifestation burden.

Results Data of 100 patients were analyzed, where 57 were female and 43 male; the median age was 27 years (IQR 21–37). Nineteen patients (19%) were classified as severe dengue and 81 (81%) as non-severe. The most frequent manifestations were fever (97%), abdominal pain (92%), arthralgia (90%), prostration (90%), myalgia (89%), headache (88%) and hepatomegaly (84%). Median laboratory values did not differ significantly between severe and non-severe groups for hemoglobin, TLC, MCV, hematocrit, platelet count, INR, bilirubin, AST, ALT, total protein, albumin, creatinine or urea (all p>0.05). DENV-2 was the most frequent single serotype (33%), followed by DENV-3 (28%), DENV-1 (13%) and DENV-4 (9%); mixed-serotype infections accounted for 17%. Mixed infections were strongly associated with severe dengue (10/17 [58.8%] severe versus 9/83 [10.8%] among single-serotype infections; Fisher’s exact p<0.001). DENV-2+DENV-3 infection was particularly associated with severe disease (6/9 [66.7%], p=0.0013).

Conclusion: The study demonstrates substantial clinical heterogeneity and co-circulation of all four dengue serotypes. Although routine laboratory parameters were not statistically different between severity groups in this dataset, mixed-serotype infection especially DENV-2+DENV-3 was associated with a markedly higher proportion of severe disease. Molecular serotyping together with systematic clinical and laboratory monitoring may improve risk stratification.