Beyond conventional markers: admission serum lactate levels as an early predictor of dengue disease severity: a retrospective cross-sectional study from a tertiary care hospital in Karachi, Pakistan

Sadaf H. Musani; Hina G. Awat; Vardah Wasim; Midrar Ullah; Minahil Rafi; Amber S. Ahmed

doi:10.18203/2394-6040.ijcmph20253232

Authors

Sadaf H. Musani Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan https://orcid.org/0000-0001-7614-8544
Hina G. Awat Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
Vardah Wasim Department of Anesthesia, Aga Khan University Hospital, Karachi, Pakistan
Midrar Ullah Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
Minahil Rafi Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
Amber S. Ahmed Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20253232

Keywords:

Pakistan, Dengue, Lactate, Severity

Abstract

Background: Dengue is a significant global health concern, with clinical manifestations ranging from mild fever to severe, life-threatening hemorrhagic shock. Despite the use of established warning signs, an effective biomarker for the early identification of severe cases remains elusive. This study aimed to investigate the utility of admission serum lactate levels as an early predictor of dengue disease severity.

Methods: A retrospective cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan, reviewing medical records from 2018 to 2022. The study included adult patients aged 18 and above who were admitted with a primary diagnosis of dengue fever and had admission serum lactate levels available. Patients with pre-existing chronic liver or kidney disease were excluded. Data on demographic characteristics, comorbidities, laboratory results (including lactate, hematocrit, and platelet count), and disease outcomes such as ICU admission, intubation, and systemic complications (cardiovascular, ARDS, CNS, acute liver failure, AKI, and mortality) were collected. Data analysis was performed using IBM SPSS Statistics, with a p value of <0.05 considered statistically significant.

Results: A total of 203 eligible patients were included in the final analysis. The study found a statistically significant association between higher median serum lactate levels and various indicators of disease severity. Higher lactate levels were significantly associated intubation, and mortality (p value <0.05). A weak negative correlation was also observed between admission lactate levels and platelet counts. No significant correlation was found between lactate and hematocrit levels.

Conclusions: Admission serum lactate levels can serve as a valuable and early predictor of overall dengue disease severity. Higher lactate levels upon hospital admission are significantly associated with a range of severe outcomes, including cardiovascular complications, ARDS, acute liver failure, AKI, intubation, and mortality.

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References

Guo C, Zhou Z, Wen Z, Liu Y, Zeng C, Xiao D, et al. Global epidemiology of dengue outbreaks in 1990-2015: a systematic review and meta-analysis. Front Cell Infect Microbiol. 2017;7:317. DOI: https://doi.org/10.3389/fcimb.2017.00317

Guha-Sapir D, Schimmer B. Dengue fever: new paradigms for a changing epidemiology. Emerg Themes Epidemiol. 2005;2(1):1. DOI: https://doi.org/10.1186/1742-7622-2-1

Hadinegoro SR. The revised WHO dengue case classification: does the system need to be modified? Pediatr Int Child Health. 2012;32[1(s1)]:33-8. DOI: https://doi.org/10.1179/2046904712Z.00000000052

Thanachartwet V, Wattanathum A, Oer-areemitr N, Jittmittraphap A, Sahassananda D, Monpassorn C, et al. Diagnostic accuracy of peripheral venous lactate and the 2009 WHO warning signs for identifying severe dengue in Thai adults: a prospective observational study. BMC Infect Dis. 2016;16:46. DOI: https://doi.org/10.1186/s12879-016-1386-5

Gupta M, Agrawal N, Sharma SK, Ansari AK, Mahmood T, Singh L. Study of utility of basic arterial blood gas parameters and lactate as prognostic markers in patients with severe dengue. Cureus. 2022;14(5):e24682. DOI: https://doi.org/10.7759/cureus.24682

Gupta S, Mall P, Alam A. Combined score based on arterial lactate, aspartate transaminase and prolonged capillary refill time is a useful diagnostic criterion for identifying severe dengue. Trans R Soc Trop Med Hyg. 2020;114(11):838-46. DOI: https://doi.org/10.1093/trstmh/traa088

Nayak P, Panda M, Jena D, Swain S, Swain SK. Study on the pattern of changes in biochemical and haematological profiles in dengue-positive patients admitted to tertiary health care hospital Puri on the first, third, seventh, and tenth days of their illness. J Cardiovasc Dis Res. 2023;14(12):204-10.

Kashif SM, Nawaz Z, Kumar D, Anum G, Qadeer R. Dengue fever and prognostic utility of inflammatory markers. Prof Med J. 2024;31(08):1188-94. DOI: https://doi.org/10.29309/TPMJ/2024.31.08.8172

Bano N, Tayyab M, Muneer B, Firyal S, Hashmi AS, Wasim M, et al. Clinical, hematological and biochemical manifestations among dengue patients of Lahore region. Pak J Zool. 2022:1-8.

Villar-Centeno LA, Díaz-Quijano FA, Martínez-Vega RA. Biochemical alterations as markers of dengue hemorrhagic fever. Am J Trop Med Hyg. 2008;78(3):370-4. DOI: https://doi.org/10.4269/ajtmh.2008.78.370

Ladani M, Shukla D, Raval R, Goyani T, Vadodaria S. Serum lactate as a predictor of severity in dengue infection. Nat J Med Res. 2023;13(1). DOI: https://doi.org/10.55489/njmr.13012023950

Sirikutt P, Kalayanarooj S. Serum lactate and lactate dehydrogenase as parameters for the prediction of dengue severity. J Med Assoc Thai. 2014;97:S220-31.

Perveen S, Firdous H, Khalid MA, Ahmed N, Baqai HZ. Relationship between serum lactate dehydrogenase levels and dengue severity. JRMC. 2017;21(1):9-12.

Farooq M, Saleem A, Farooq M, Ejaz M. Association of dengue severity with host biomarkers. Pak Armed Forces Med J. 2024;74(4):1046. DOI: https://doi.org/10.51253/pafmj.v74i4.9720

Raju Naik R, Prabha J, Kumar A. A study on serum lactate dehydrogenase as prognostic indicator in patients with dengue fever. An observational cross-sectional study in North Delhi. Int J Med Pub Health 2025;15(1);875-82.

Equebal A, Dhanawade S. Study of serum lactate dehydrogenase levels in critically ill dengue patients admitted in PICU. Pediatr Infect Dis. 2022;3(3):91-4. DOI: https://doi.org/10.5005/jp-journals-10081-1302

Kasarabada H, Iyengar SS, Singh D, Kushala P, Joshi SK, Dayanand K. Observational study of using lactate dehydrogenase as prognostic marker in dengue patients. Med J Armed Forces India. 2025;81(3):275-81. DOI: https://doi.org/10.1016/j.mjafi.2023.07.009

Mittal SH, Mittal S, Govil T. Devising a prognostic predictive scale based on lactate dehydrogenase levels in dengue. Astrocyte. 2015;2(2):69-71. DOI: https://doi.org/10.4103/2349-0977.172679

Al‐Samkari H, Kuter DJ. Lactate dehydrogenase is elevated in immune thrombocytopenia and inversely correlates with platelet count. Br J Hematol. 2019;187(3):61-4. DOI: https://doi.org/10.1111/bjh.16183