SPECTRUM, PREDICTORS, AND OUTCOMES OF HEMORRHAGIC MANIFESTATIONS IN DENGUE FEVER: A PROSPECTIVE OBSERVATIONAL STUDY FROM A TERTIARY CARE HOSPITAL IN PAKISTAN

Abstract

Background: Dengue fever is a viral infection and in severe cases it can leads to hemorrhagic symptoms which can be fatal. Secondary dengue infection and co-morbidities have been found to be risk factors for severe dengue and hemorrhagic symptoms. Aim: The aim of this study was to determine the Spectrum, Predictors, and Outcomes of Hemorrhagic Manifestations in Dengue Fever in patients with confirmed dengue fever admitted to a tertiary care hospital in Nowshera, Pakistan. Materials and method: The present observational cohort study was conducted in the Department of Medicine at Nowshera Medical College, Qazi Hussain Ahmad Medical Complex Nowshera over a period of 12 months, from January 2025 to January 2026 after taking approval from the ethical committee of the hospital. Individuals of both gender and different age groups admitted to the hospital throughout the research period with Laboratory-confirmed dengue fever (positive NS1 antigen and/or dengue IgM antibodies) were included. A standardized proforma was used to record demographics, clinical data, and laboratory results. Hemorrhagic symptoms were testified and categorized. The statistical analysis was carried out using IBM SPSS version 26. Chi-square testing and multivariate logistic regression were used to investigate variables related to hemorrhagic symptoms. A p-value of <0.05 was considered statistically significant. Results: In the current study a total of 400 individuals with laboratory-confirmed dengue fever were participated out of which 162 (40.5%) were females and 238 (59.5%) were male. The mean age of the study population was 33.9 ± 12.3 years (range: 6–78 years).  Among the study participants 116 (29.0%) individuals had hemorrhagic symptoms. Participants with platelet counts below 50 × 10⁹/L exhibited a considerably greater prevalence of hemorrhagic symptoms compared to those no bleeding which was statistically significant  (p < 0.001). Individuals with a hematocrit level of ≥45% had a significantly higher risk of hemorrhagic symptoms compared to those absent bleeding (p < 0.001). Elevated ALT levels above 100 U/L were also substantially related with bleeding symptoms.  Diabetes mellitus was substantially related with hemorrhagic symptoms (p = 0.001). Similarly, hypertension was significantly associated with bleeding problems (p = 0.013). Patients who presented with hemorrhagic symptoms had considerably poorer clinical outcomes. Conclusion: The current study concluded that hemorrhagic manifestations were seen in 29% of the individuals with dengue fever. The independent predictors of bleeding were thrombocytopenia, severe dengue, coagulation problems and hemoconcentration. Early identification of these risk factors may allow for more effective therapy and better clinical results.