| Background:Dengue fever(DF)is an acute infectious disease caused by the dengue virus and is endemic worldwide,mainly in the tropical and subtropical regions.The number of DF cases has increased dramatically over the last two decades,resulting in a huge burden of disease in many countries around the world.Most patients are asymptomatic after infection,with only a few patients experiencing mild or moderate fever,headache,muscle pain,and joint pain.Patients with severe dengue(SD)may present with more serious manifestations,including shock,gastrointestinal bleeding,nosebleeds,vaginal bleeding,and other impacts affecting multiple organs throughout the body,with a mortality rate of up to 20%if left untreated.The pathogenesis of SD is unknown and has been suggested to be related to viral factors,host factors,and antibody-dependent enhancements(ADE),including the patient’s immune status,cytokine levels,and underlying diseases.Foreign studies have suggested that SD may be associated with pre-existing underlying conditions.Patients with DF combined with underlying diseases such as hypertension and diabetes mellitus are associated with a significantly increased risk of severe disease;however,so far,there have been few studies on the correlation between DF and underlying diseases in China.Objective:To investigate the clinical characteristics and risk factors for severe illness in DF patients with underlying diseases,with a view to provide a scientific basis for early diagnosis and triage for clinical management.Methods:1.Participants and content of the study:Demographic data,clinical manifestations,laboratory findings,imaging data,regression,and other indicators of 1920 hospitalized dengue patients admitted to City Hospital No.8 of Guangzhou Medical University from 2013-2019 were collected,and general conditions such as age and sex were compared between the basic disease group and the group without basic disease;laboratory indicators,imaging,and other indicators were compared between the general and severe disease groups.2.Study methods:Charlson comorbidity index(CCI)was used to analyse the relationship between patients with dengue and disease severity;multi-factor regression analysis was used to analyse the risk factors for severe disease in patients with DF.Results:1.Investigate the clinical characteristics and risk factors of SD in adult patients with DF complicated with underlying diseases:1.1 The incidence of dengue combined with underlying disease was 38.9%(746/1920);the median age of the underlying disease group was 20 years older than that of the group without underlying disease,and the difference was statistically significant(Z=-18.608,P<0.001);the incidence of serious illness in the underlying disease group was 11.7%,and that in the group without underlying disease was 4.4%,and the difference between the two groups was statistically significant(χ2=35.535,P<0.001);the differences between the intensive care unit admission rate and the number of days of hospitalization between the group with and without underlying diseases were statistically significant(P<0.05);the incidence rates of the underlying disease group were 18.1%had hypertension(347 cases),6.7%had diabetes mellitus(129 cases),4.9%had coronary heart disease(95 cases),4.6%had chronic viral hepatitis(90 cases),3.6%had hyperlipidemia(70 cases),3.2%had stroke(63 cases),2.6%had chronic obstructive pulmonary disease(50 cases),and 2.0%had G6PD deficiency(39 cases).1.2 When comparing the clinical symptoms of patients with DF combined with underlying diseases between the severe and general groups,the incidence of dizziness,vomiting,black or bloody stools,bone pain,hematuria,vomiting,and subcutaneous hematoma was significantly higher in the severe group than in the general group(P<0.05).The differences in white blood cell count,hemoglobin,erythrocyte volume,serum albumin,aspartate aminotransferase,creatine kinase,lactate dehydrogenase,prothrombin time,activated partial thromboplastin time and international standardized ratio between the severe group and the general group were statistically significant(P<0.05);pericardial effusion,pleural effusion and ascites were higher in the severe group than in the general group,and the differences were statistically significant(P<0.05).1.3 The relationship between the Charlson Comorbidity Index(CCI)and the disease severity:The CCI was divided into CCI<3 and CCI≥3 groups.It was found that the incidence of serious illness was significantly higher in CCI≥3 groups than in CCI<3 groups,and the difference was statistically significant(χ2=46.721,P<0.001),suggesting that the incidence of serious illnesses was significantly higher in the CCI group and that the incidence of serious illnesses was significantly higher at≥3 points.1.4 Hypertension,diabetes,coronary heart disease,stroke,chronic obstructive pulmonary disease,chronic kidney disease,and peptic ulcer were significantly different between the severe illness and general groups(P<0.05),diabetes,coronary heart disease,stroke,chronic obstructive pulmonary disease,and peptic ulcer were risk factors for the development of SD.2.Study of the clinical characteristics and risk factors of patients with dengue fever combined with hypertension:2.1 The 347 patients with DF and hypertension were divided into severe and general groups according to the severity of their illness.The mean age of the severe group was 74.0± 10.9 years and the mean age of the general group was 67.4± 11.8 years,and the difference in age between the two groups was statistically significant(t=-3.929,P<0.001).In all,112 people(32.2%)had hypertension grade 1;114 people(32.9%)had hypertension grade 2;and 121 people(34.9%)had hypertension grade 3.The difference in hypertension grade 3 in the severe group and the general group was statistically significant(χ2=6.100,P=0.014).Fifty-seven(50.9%)patients with hypertension grade 1 improved,52(46.4%)were cured,2(1.8%)were not cured and 1(0.9%)died;123(52.3%)of patients with hypertension grades 2 and 3 improved,107(45.5%)were cured,3(1.3%)were not cured and 1(0.9%)died);none of the differences were statistically significant(P>0.05).The differences in white blood cell count,platelet count,hemoglobin,erythrocyte-specific volume,serum albumin,alanine aminotransferase,aspartate aminotransferase,and lactate dehydrogenase levels between the severe and general groups were statistically significant(P<0.05).On imaging,patients in the severe group had a significantly higher proportion of pleural effusions than those in the general group(χ2=14.666,P<0.001).2.2 The incidence of other underlying diseases among patients with dengue combined with hypertension was 23.3%(81 cases)for diabetes mellitus,21.9%(76 cases)for coronary heart disease,6.3%(22 cases)for chronic obstructive pulmonary disease,13.3%(46 cases)for stroke,and 3.2%(11 cases)for chronic kidney disease;in the severe and general groups,the differences in diabetes mellitus,coronary heart disease,stroke,and chronic obstructive pulmonary disease were statistically significant(P<0.05).2.3 The incidence of severe illness was higher in hypertension grade 3(23.1%)than in grade 1(12.5%),with a statistically significant difference between the two groups(χ2=4.457,P=0.035).The incidence of severe illness was higher in patients with grade 3 hypertension(23.1%)than in grade 2(13.2%),with a statistically significant difference between the two groups(χ2=3.913,P=0.048).2.4 The proportion of patients taking antihypertensive drugs were 73.7%and 46.9%in the severe and general groups,respectively.The differences between the two groups were statistically significant(χ2=13.682,P<0.001).Conclusion:1.The most common underlying disease for DF in adults is hypertension.2.Diabetes mellitus,coronary heart disease,chronic obstructive pulmonary disease,stroke,and peptic ulcers are risk factors for SD,and the incidence of SD is higher in patients with grade 3 hypertension than in those with grades 1 or 2. |
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