Clinical and haematological correlates of severe dengue using 2023 epidemic data: a multicentre tertiary hospital-based analysis from Dhaka, Bangladesh

Abstract Background Dengue fever, caused by the dengue virus (DENV), is a significant public health threat in tropical and subtropical regions. The 2023 outbreak in Dhaka City, Bangladesh, resulted in over 321,000 reported cases and 1,705 deaths, highlighting the urgent need for understanding factors associated with disease severity. Methods This multi-center, hospital-based study analyzed 466 laboratory-confirmed dengue cases admitted to four tertiary hospitals in Dhaka during the peak epidemic period (September 1 to October 31, 2023). Demographic, clinical, and laboratory data were collected using a semi-structured questionnaire. Cases were categorized based on severity, and statistical analyses were performed to identify predictors of severe dengue. Results Severe dengue was associated with older age (OR = 1.77; p <0.001), blood transfusion requirements (OR = 15.26; p <0.001), elevated hematocrit (OR = 15.16; p <0.001), and lower body mass index (BMI) (OR = 0.11; p <0.001). Delays in seeking medical care significantly correlated with increased severity (p = 0.007). Symptomatic markers such as abdominal pain (p < 0.001) and respiratory distress (p = 0.013) were strong indicators of severe outcomes. Conclusions Our findings underscore the importance of timely medical intervention and highlight demographic and clinical factors that may contribute to severe dengue progression. The association between lower BMI and disease severity warrants further investigation. These insights can inform targeted public health strategies and improve clinical management during dengue outbreaks. Author Summary Dengue poses a significant public health challenge in Bangladesh. To better understand the epidemiological and clinical characteristics of dengue in Dhaka city, we conducted a study on 466 patients admitted to four distinct tertiary hospitals during the 2023 outbreak. Dengue cases were identified through serological testing for the presence of the NS1 antigen. Our analysis revealed that older age, the need for blood transfusions, elevated hematocrit levels, and lower body mass index were significant predictors of severe dengue outcomes. Furthermore, delays in seeking medical care were strongly correlated with increased disease severity, highlighting the critical importance of timely intervention. Symptoms such as abdominal pain and respiratory distress emerged as strong indicators of severe dengue. These findings emphasize the complex interplay of various factors in determining dengue severity and underscore the need for context-specific public health strategies. By identifying these predictors, healthcare providers can enhance the management of severe dengue cases and reduce the impact of future outbreaks.