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.