Peripheral Hematological Predictors of Severity and Mortality in Current Dengue Outbreak in a Hospital-Based Study at Nowshera

Abstract

Objectives: To determine the predictive role of peripheral hematological markers for severity and mortality during the 2024 dengue outbreak in Nowshera.

Methodology: This prospective observational study included 178 patients who tested positive for Non-structural protein 1 (NS1) using an immunochromatographic test (ICT). Out of these, 116 NS1-positive samples were sent for serotyping to the National Institute of Health (NIH), with the support of the Public Health Research Laboratory at Khyber Medical University (PHRL-KMU), Peshawar. Various statistical tools were applied to assess the predictive value of hematological and biochemical markers for mortality in dengue infection.

Results: A total of 178 cases were analyzed, comprising 96 (53.8%) males and 82 (46.1%) females. Of the 116 samples sent for serotyping, 72 (62.1%) were PCR-positive, and among these, 66 (91.7%) were identified as DENV-2. There were 10 reported deaths. Significant differences in age, hemoglobin (Hb%), and platelet counts were noted between deceased and surviving patients with p-values of 0.09, 0.01, and 0.001 respectively, indicating statistical significance in predicting mortality. An increase in hematocrit levels was also observed in deceased patients. Thrombocytopenia emerged as a red flag in the deceased group. Notably, 9 out of the 10 deaths occurred in patients with DENV-2 serotype.

Female gender appeared to be relatively protective compared to male gender. Lower platelet and leukocyte counts demonstrated high clinical sensitivity for predicting mortality, with areas under the ROC curve (AUC) of 0.9 and 0.7, respectively.

Conclusion: Peripheral blood parameters, including decreased platelet count, elevated hematocrit, and low total leukocyte count (TLC), were found to be significant predictors of mortality with 95% confidence. Female patients had better survival outcomes across all age groups. Although age and hemoglobin levels showed trends, they were not statistically significant predictors of mortality. Recognizing these hematological markers in clinical settings can aid in early identification of high-risk patients and potentially reduce dengue-related mortality.

Key words: Dengue Fever, Mortality, Platelet count, Hematological markers