Prevalence and Outcomes of Myocarditis in Dengue-Infected Patients Admitted at a Tertiary Care Hospital of Low-Middle Income Country

Abdul Baqi; Fazal ur Rehman; Pirbhat Shams Memon; Syed Furrukh Omair

doi:10.5334/gh.1129

Figures & Tables

Table 1

Clinical and biochemical characteristics of dengue-infected patients (n = 1008). SCD = sudden cardiac death; PBNP = Pro brain natriuretic peptide; ECG = electrocardiography; ECHO = echocardiography; LAMA = left against medical advice; IQR = interquartile range.

CHARACTERISTICS OF DENGUE-INFECTED PATIENTS (N= 1008)	N (%)
Age (>35 years)	558 (55.4)
Gender (Male)	689 (68.4)
DM	109 (10.8)
Hypertension	125 (12.4)
Creatinine (>1.3 mg/dl)	114 (12.2)
Platelets × 10⁹/L
>150,000	151 (15)
40,000 to 150,000	566 (56.2)
<40,000	291 (28.9)
Discharge mode
Discharge	937 (93)
LAMA	55 (5.5)
In-hospital mortality	16 (1.6)
PROFILE OF DENGUE MYOCARDITIS PATIENTS (N= 42)	N (%)
Dyspnea	18 (42.9)
Palpitations	4 (9.5)
Shock (any)	12 (28.6)
Cardiogenic shock	4 (9.5)
Syncope	1 (2.4)
Aborted SCD	–
Fatigue	33 (78.6)
Fever	36 (85.7)
Troponin levels (>0.04)	42 (4.16)
PBNP pg/ml (Median IQR)	4609 (86–23300)
ECG abnormalities (at least one)	25 (59.5)
ECHO abnormalities (at least one)	10 (24)

Table 2

Socio-demographic and clinical characteristics of dengue patients by length of stay and in-hospital mortality. (n=1008). DM = diabetes mellitus; AVB = atrioventricular block; SCD = sudden cardiac death; ECG = electrocardiography; ECHO = echocardiography.

	LENGTH OF STAY					CRUDE			MORTALITY					CRUDE
	≤3 DAYS		>3 DAYS		P-VALUE	OR	95%CI		YES		NO		P-VALUE	OR	95%CI
	N	%	N	%	P-VALUE				N	%	N	%	P-VALUE
Age (Years)
≤35	359	45.6	91	41.2	0.24	1			6	37.5	444	44.8	0.56	1
>35	428	54.4	130	58.8	0.24	1.19	0.88	1.62	10	62.5	548	55.2	0.56	1.35	0.48	3.74
Gender
Male	549	69.8	140	63.3	0.07	1			10	62.5	679	68.4	0.61	1
Female	238	30.2	81	36.7	0.07	1.34	0.97	1.83	6	37.5	313	31.6	0.61	1.3	0.45	3.61
DM
No	710	90.2	189	85.5	0.04	1			9	56.3	890	89.7	<0.001	1
Yes	77	9.8	32	14.5	0.04	1.56	1.01	2.43	7	43.8	102	10.3	<0.001	6.78	2.47	18.61
Hypertension
No	716	91	167	75.6	<0.001	1			9	56.3	874	88.1	<0.001	1
Yes	71	9	54	24.4	<0.001	3.26	2.2	4.83	7	43.8	118	11.9	<0.001	5.76	2.11	15.76
Dyspnea
No	6	50	18	60	0.55	1			2	22.2	22	66.7	0.02	1
Yes	6	50	12	40	0.55	0.66	0.17	2.56	7	77.8	11	33.3	0.02	7	1.24	39.49
Chest Pain
No	12	100	29	96.7	1	NA			9	100	32	97	1	NA
Yes	0	0	1	3.3	1	NA			0	0	1	3	1	NA
Palpitations
No	9	75	29	96.7	0.06	1			7	77.8	31	93.9	0.2	1
Yes	3	25	1	3.3	0.06	0.1	0.01	1.12	2	22.2	2	6.1	0.2	4.43	0.53	37.06
Syncope
No	12	100	29	96.7	1	NA			9	100	32	97	1	NA
Yes	0	0	1	3.3	1	NA			0	0	1	3	1	NA
Shock
No	9	75	29	96.7	0.06	1			7	77.8	31	93.9	0.2	1
Yes	3	25	1	3.3	0.06	0.1	0.01	1.12	2	22.2	2	6.1	0.2	4.43	0.53	37.07
Aborted SCD
No	12	100	30	100	NA	NA			9	100	33	100	NA	NA
Yes	0	0	0	0	NA	NA			0	0	0	0	NA	NA
Platelets
>150,000	111	14.1	40	18.1		1			3	18.8	148	14.9		1
40 to 150,000	441	56	125	56.6	0.22	0.78	0.52	1.18	5	31.3	561	56.6	0.09	0.44	0.1	1.86
<40,000	235	29.9	56	25.3	0.22	0.66	0.42	1.05	8	50	283	28.5	0.09	1.39	0.36	5.33
Bicarbonate
≥22	623	82.8	139	65.9	<0.001	1			2	12.5	760	80.3	<0.001	1
<22	129	17.2	72	34.1	<0.001	2.5	1.77	3.52	14	87.5	187	19.7	<0.001	28.45	6.41	126.26
Creatinine
≤1.3	666	92	155	73.5	<0.001	1			4	25	817	88.9	<0.001	1
>1.3	58	8	56	26.5	<0.001	4.15	2.76	6.23	102	75	12	11.1	<0.001	24.02	7.61	75.9
Troponin-I
≤ 0.04	59	84.3	34	52.3	<0.001	1			4	30.8	89	73	0.003	1
>0.04	11	15.7	31	47.7	<0.001	4.89	2.18	10.96	9	69.2	33	27	0.003	6.07	1.75	21.05
Echo findings
Normal	783	99.5	204	92.3	<0.001	1			13	81.3	974	98.2	0.004	NA
Abnormal	4	0.5	17	7.7	<0.001	16.31	5.43	49.01	3	18.8	18	1.8	0.004	NA
AVB
No	10	100	29	100	NA	NA			8	100	31	100	NA	NA
Yes	0	0	0	0	NA	NA			0	0	0	0	NA	NA
Atrial Fibrillation
No	9	90	23	79.3	0.65	1			5	62.5	27	87.1	0.14	1
Yes	1	10	6	20.7	0.65	2.35	0.25	22.34	3	37.5	4	12.9	0.14	4.05	0.68	23.9
Diastolic Dysfunction
None	2	40	2	8.7		NA			2	33.3	2	9.5		1
Grade I	0	0	14	60.9	0.03				3	50	11	52.4	0.31	0.27	0.03	2.83
Grade II	3	60	6	26.1					1	16.7	8	38.1		0.12	0.007	2.17

Table 3

Association of myocarditis with morbidity and mortality (n = 1008). aOR = adjusted odds ratio; CI = confidence interval.

	LENGTH OF STAY > 3 DAYS			MORTALITY
	AOR	95% CI		AOR	95% CI
Age (Years)
≤35	1			1
>35	0.66	0.24	1.81	0.22	0.04	1.34
Gender
Male	1			1
Female	1.24	0.55	2.77	2.82	0.68	11.67
Troponin levels
≤0.04	1			1
>0.04	5.29	2.16	12.96	8.2	1.83	36.84
Diabetes Mellitus
No	1			1
Yes	0.67	0.27	1.68	1.48	0.34	6.49
Platelets
>150,000	1			1
40 to 150,000	0.41	0.13	1.32	0.28	0.04	1.95
<40,000	0.37	0.1	1.31	0.63	0.09	4.33
Echo Findings
Normal	1			1
Any cardiac abnormality	4.38	1.26	15.27	2.24	0.42	11.97

Prevalence and Outcomes of Myocarditis in Dengue-Infected Patients Admitted at a Tertiary Care Hospital of Low-Middle Income Country

Figures & Tables

Table 1

Table 2

Table 3

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