| सारांश: | Dengue fever (DF) has unpredictable clinical progressions and outcomes. With the
increasing prevalence of obesity, diabetes, and hypertension, these risk factors will likely
play a more significant role in increasing the burden and mortality related to dengue
infection. This study seeks to determine the association between obesity, diabetes,
hypertension, and dengue severity (DS) in confirmed dengue cases among those aged 15
years and above in Malaysia’s primary health care setting. A cohort study was conducted
in the central region of Peninsular Malaysia from May 2016 to November 2017. We
collected demographic, clinical history, physical examination, and laboratory
examination information. The exposures of interest were obesity, diabetes, and
hypertension. DS was defined as either dengue with warning signs or severe dengue.
Participants underwent daily follow-up during which we recorded their vital signs, full
blood count, and random blood sugar (RBS) results. The prevalence and incidence of DS
were modelled using multivariable and random intercept logistic regression. The changes
in platelet and hematocrit levels were modelled using random intercept linear regression.
The final model of obesity was adjusted for age, gender, and ethnicity. Similarly, the final
model of diabetes and hypertension was adjusted for age, gender, ethnicity, and Body
Mass Index (BMI) categories. Out of 362 dengue patients, 48.9% were diagnosed with
DS at enrolment. Based on the association between obesity and DS, we found significant
associations between: (i) BMI (kg/m2
) and prevalence of DS (Adjusted Odds Ratio
(aOR)=1.04; 95% Confidence Interval (CI):1.00,1.08; p=0.034); (ii) BMI (kg/m2
) and
incidence of DS (aOR=1.15; 95% CI:1.03,1.28; p=0.016); (iii) BMI (kg/m2
) and
hematocrit (%) (Adjusted Beta (aβ)=0.09; 95% CI:0.01,0.17; p=0.021); (iv) BMI (kg/m2
)
and changes in hematocrit (%) (aβ=0.07; 95% CI:0.003,0.15; p=0.041); (v) obese and
iv
hematocrit (%) (aβ=1.77; 95% CI:0.53,3.01; p=0.005); (vi) obese and changes in
hematocrit (%) (aβ=1.39; 95% CI:0.25,2.53; p=0.017); (vii) waist circumference (cm)
and changes in platelet (x103
/µL) at phase 3 of DF (aβ=0.84; 95% CI:0.24,1.45; p=0.006);
and (viii) abdominal obesity and changes in platelet (x103
/µL) at phase 3 of DF
(aβ=21.08; 95% CI:6.03,36.13; p=0.006). For the association between diabetes and DS,
we found significant associations between: (i) RBS (mmol/L) among non-diabetes and
incidence of DS (aOR=1.57; 95% CI:1.13,2.18; p=0.007); (ii) RBS (mmol/L) and platelet
(x103
/µL) (aβ=-2.49; 95% CI:-4.83,-0.16; p=0.037); (iii) RBS (mmol/L) and changes in
platelet (x103
/µL) at phase 2 of DF (aβ=-2.74; 95% CI:-4.93,-0.54; p=0.014); (iv) RBS
(mmol/L) among non-diabetes and changes in platelet levels at phase 2 of DF (aβ=-4.53;
95% CI:-7.72,-1.34; p=0.005); (v) diabetes and incidence of DS at phase 1 of DF
(aOR=20.89; 95% CI:1.08,403.96; p=0.044); and (vi) diabetes and changes in platelet
(x103
/µL) at phase 3 of DF (aβ=44.29; 95% CI:21.28,67.30; p<0.001). In the association
between hypertension and DS, we only found significant associations between
hypertension and changes in platelet (x103
/µL) at phase 3 of DF (aβ=37.70; 95%
CI:11.50,63.91; p=0.005). This is the first study that determines the associations between
obesity, diabetes, hypertension and DS. These risk factors play an important role in risk
stratifying dengue patients
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