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May 30, 2026

Prevalence and factors associated with cardiac involvement in hospitalized patients with dengue: a cross-sectional study

Key Points

The aim is to estimate the prevalence and identify predictors of cardiac involvement in hospitalized dengue patients.
Cross-sectional study of 919 hospitalized patients with confirmed dengue.
Cardiac involvement assessed via clinical features, ECG changes, cardiac biomarkers, or echocardiographic abnormalities.
Multivariable logistic regression and CART model utilized for predictors and risk stratification.
14% of patients exhibited cardiac involvement, including pericardial effusion (26%) and elevated hs-troponin I (38%).
Significant predictors included age >60 years (aOR 3.05, 95% CI 1.53 to 6.08) 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 risk factors.

Abstract

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.

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