ArticlePloS one2026
Mortality predictors, hepatic involvement patterns, and the steatotic liver paradox in 1,484 hospitalized Dengue patients.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
objectivesDengue fever represents a major global health burden with hepatic involvement occurring in up to 90% of hospitalized patients. This study aimed to determine in-hospital mortality predictors, characterize clinical outcomes across graded hepatic injury phenotypes, and validate prognostic scoring systems in hospitalized dengue patients. A primary focus was assessing the impact of pre-existing liver conditions on disease trajectory and survival.
methodsA retrospective cohort analysis was conducted on 1,484 patients with laboratory-confirmed dengue infection admitted to a tertiary-care center between 2021 and 2024. Patients were stratified by hepatic status into those with pre-existing chronic liver disease, non-chronic steatotic liver involvement, and no liver involvement. Multivariable logistic regression identified independent mortality predictors, while unsupervised clustering distinguished clinical phenotypes. The performance of physiological and liver-specific prognostic scores was evaluated against clinical outcomes.
resultsThe overall in-hospital mortality rate was 5.1%, with 13.1% requiring intensive care admission. Independent predictors of mortality included severe dengue classification, intensive care unit admission, elevated neutrophil-to-lymphocyte ratio, and hypoalbuminemia, with albumin emerging as the strongest single biomarker for risk prediction. Paradoxically, patients with steatotic liver disease demonstrated improved survival compared to those without pre-existing liver disease, supporting an "obesity paradox" in this tropical infection context, whereas decompensated cirrhosis was associated with markedly adverse outcomes. The Albumin-Bilirubin grade successfully stratified hepatic risk, and the Simplified Acute Physiology Score-3 significantly outperformed the Sequential Organ Failure Assessment for predicting mortality in critically ill patients. Four distinct clinical phenotypes with differential mortality ranging from 3.0% to 100% were identified.
conclusionsHypoalbuminemia serves as a critical, accessible prognostic marker in dengue fever. Pre-existing liver pathology demonstrates divergent impacts on outcomes, with steatotic liver disease potentially conferring survival advantage contrary to traditional metabolic risk assumptions. These findings support the utility of liver-specific scoring systems for acute risk stratification in dengue-endemic regions.
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