Incidence of acute pancreatitis among hospitalized patients with dengue: A systematic review and meta-analysis

Background Acute pancreatitis (AP) is an under-recognized but clinically relevant complication of dengue fever (DF), associated with rapid clinical deterioration and increased risk of mortality. However, the true incidence of this condition remains uncertain. Methods Following PRISMA 2020 guidelines, we systematically searched PubMed, Web of Science, Embase and China National Knowledge Infrastructure (CNKI) up to May 2025 for observational studies reporting AP among DF hospitalized patients. Eligible studies were identified according to predefined inclusion and exclusion criteria based on the Population, Intervention, Comparison, Outcome, and Study design (PICOS) framework. Two reviewers independently screened the literature and assessed study quality using the Newcastle–Ottawa Scale (NOS). Pooled incidence rates were estimated using random or common effect models depending on heterogeneity. Results Eight observational studies from five countries, comprising 1,078 hospitalized patients with DF, were included. Among them, 135 were diagnosed with AP. The pooled incidence of AP complicating DF was 12.4% (95% CI : 10.5–14.4%). Subgroup analysis suggested a higher incidence in studies with ≥100 participants compared to smaller cohorts (13.5% vs. 8.3%, P = 0.03). No evidence of significant publication bias was detected. Conclusion DF-associated AP represents a clinically important complication, given the global burden of dengue and the potential severity of AP. Our findings underscore the importance of considering pancreatic enzyme testing, supplemented by imaging when clinically warranted, in dengue patients with persistent or severe abdominal symptoms and/or features of severe dengue. Large-scale, multicenter prospective studies are warranted to establish the true incidence and case-fatality risk, thereby informing evidence-based prevention and management strategies.