Key result
Comorbidities and raised neutrophil-lymphocyte ratio linked to ~10-fold higher odds of dengue myocarditis.
Why the study?
Dengue illness is rising in Bangladesh and can cause severe organ involvement such as myocarditis, but risk factors, clinic-laboratory profile, and outcomes in hospitalized patients required investigation.
Case-Control (n=115)
No
In hospitalized patients with dengue infection, the presence of comorbidities and a raised neutrophil-lymphocyte ratio are strongly associated with the development of dengue myocarditis.
May inform myocarditis risk stratification in dengue; hypothesis-generating and requires prospective validation.
Background A major global health problem is dengue illness, which is rising in Bangladesh between 2019 and 2023. Dengue infections can present with a wide range of symptoms, from fever to severe organ involvement like myocarditis. In this retrospective analysis, risk factors, clinic-laboratory profile, and outcomes of dengue myocarditis in hospitalised patients were investigated. Methods The study was a retrospective one, conducted in a tertiary private hospital in Dhaka between 2019 and 2023. Dengue infection was diagnosed by positive dengue nonstructural antigen (NS1) tests and/or dengue IgM or dengue RT-PCR (reverse transcription polymerase chain reaction) positivity. Dengue myocarditis was diagnosed with the European Society of Cardiology (ESC) 2013 consensus statement. For each myocarditis patient, we recruited age-, gender-, and year-of-admission-matched control dengue patients. Results Thirty-four dengue-myocarditis patients and 81 matched dengue patients were recruited as controls, with the mean age of myocarditis patients being 48.5 ± 20.1 years; 20.7% were from the 60-69 age group, and 21 (61.7%) were male. Mean (±standard deviation) leucocyte count 9.1 (±4.7) ×109/L, alanine aminotransferase (ALT) 604 (±937) IU/L, aspartate aminotransferase (AST) 2076 (±4202) IU/L, and C-reactive protein (CRP) 5.5 (±5.3) mg/dL were significantly higher in the myocarditis group. Among 34 myocarditis patients, four patients (11.7%) died, with procalcitonin 18.8 (±27.5) ng/mL, prothrombin time (PT) 28.7 (±12.4) seconds, and activated partial thromboplastin time (APTT) 102.6 (±46.9) seconds being significantly higher. Multivariable logistic regression showed that the presence of comorbidities (odds ratio [OR]: 10.5; 95% confidence interval [CI]: 2.78-39.5]) and a raised neutrophil-lymphocyte ratio (NLR) (OR 11.9; 95% CI: 2.82-50.7) were significantly associated with myocarditis. Conclusion The presence of comorbidities and a higher NLR ratio were significantly associated with developing dengue myocarditis.
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Marisa et al. (2025) conducted a case-control in Dengue myocarditis (n=115). Presence of comorbidities vs. Absence of comorbidities was evaluated on Dengue myocarditis (OR 10.5, 95% CI 2.78-39.5, p=<0.001). The presence of comorbidities (OR 10.5) and a raised neutrophil-lymphocyte ratio (OR 11.9) were significantly associated with the development of dengue myocarditis in hospitalized patients.
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