CLINICAL COURSE AND OUTCOME OF PATIENTS WITH DENGUE FEVER, DENGUE HEMORRHAGIC FEVER AND DENGUE SHOCK SYNDROME IN A TERTIARY CARE HOSPITAL IN RECENT ENDEMIC 2022

Background: Dengue fever cases have been increased almost 30-fold over last 50 years and now reaches an estimated 100 million clinically apparent infections annually. This rapid increase in the incidence of dengue fever cases has become a threat not only to public health globally but also economic burden to developing countries like Pakistan and also other countries of South- Asia. Objective: To assess clinical course and outcome in patients with dengue fever, dengue hemorrhagic fever and dengue shock syndrome in patients in a tertiary care hospital. Methods: This cross-sectional study was conducted in the department of Medicine, Fatima Memorial Hospital, Lahore from September to November 2022. Data of all those patients who had dengue fever, dengue hemorrhagic fever and dengue shock syndrome was collected carefully. Laboratory tests were evaluated for the positivity of dengue fever by either NS1 or IgM. All patients who had positive of any of these tests were included in our study. Other laboratory tests (CBC-ESR, serum electrolytes, LFTs, RFTs, Urine analysis, chest x-ray and ultrasound abdomen and chest) were also included to assess the severity of dengue infection. These laboratory tests were repeated at least three times, one day apart to see any improvement or worsening of condition. We divided these patients in three groups according to severity of disease. Data were analyzed by SPSS- version 23. ANOVA was applied for continuous variable and chi-square was applied for categorical variables.    Results: The study comprised a total of 207 dengue patients. Distribution of gender, with 58% of the patients were men and 42% were women.  The patients were divided into three groups based on their dengue infection severity type: dengue fever, dengue hemorrhagic fever, or dengue shock syndrome. There was no significant difference in blood pressure of dengue fever and dengue hemorrhagic fever, but significant fall of Blood pressure was found in dengue shock syndrome. Similarly respiratory rate change was found in DSS. Temperature changes in these patients were not significant in all types of dengue virus infection. There were significant differences in the oxygen saturation values in dengue fever, dengue hemorrhagic fever and dengue shock syndrome and across the several dengue strains DNV1-4 (p 0.001). The analysis of laboratory data showed that the levels of hemoglobin, hematocrit, platelet count, white blood cell count, alanine transaminase (ALT), and aspartate transaminase (AST) varied considerably across the various dengue severity levels. Conclusion: In our study it was shown that patients had variable level of severity at the time of presentation, and most of patients can be treated but patients who presented late, developed complications and even death in few patients, patients who presented with shock, most of them expired and female to male ratio was different, as most of females expired. There was also significant different oxygen saturation level according to severity of dengue infection. Platelets count was significant but not of predictive value for severity of dengue infection, as patients with very low platelets count recovered.