1. Troponin Elevation is Strongly Associated with Death in Dengue Patients with Cardiac Involvement
Ariane Vieira Scarlatelli Macedo1, Simone Ramalho1, Henrique Patrus Mundim Pena1, Yolanda Martins Faria Ornellas1, Carlos Eduardo Ornelas1
1Cardiology Department and Intensive Care Unit – Rede Mater Dei de Saúde, Belo Horizonte/MG, Brazil. The authors declare that there is no conflict of interest.
INTRODUCTION
RESULTS
RESULTS
There were 4 (6,56%) fatal cases and 57 (93,44%) nonfatal patients. There was no difference according to clinical dengue classification, duration of symptoms, pre-existing comorbidities and demographic characteristics between fatal and nonfatal cases (table 1). Nevertheless, we observed that troponin I elevation (p<0.001) and coronary catheterization (p 0.045) performed during the hospitalization were significantly associated with death in dengue patients (chart 1).
Dengue is currently one of the most important emerging infectious diseases in the world, and complications involving organ systems are seen with varying incidence1,2. Cardiac involvement is not uncommon in dengue infection and may be associated with significant morbidity and even mortality2,3. Understanding the risk factors for progression to severe cardiac manifestations of dengue and death is essential in determining triage and management algorithms.
objeCTIVE
The aim of this study is to characterize the impact of pre-existing comorbidities and elevated cardiac biomarker among dengue adults with cardiac involvement at a tertiary hospital at risk of progression with severe organ involvement and death.
Chart 1 – Factors influencing risk of death – multivariate analysis.
CONCLUSION
In patients with cardiac involvement dengue, despite baseline clinical characteristics and dengue presentation, troponin elevation can be associated with a fatal outcome. This association needs to be validated in a larger study and will be useful for triage by clinicians for prompt monitoring and clinical management at first presentation.
METHODS
We conducted a retrospective study of hospitalized adult patients between 2010 and 2016 with confirmed dengue fever and cardiac involvement at presentation (inappropriate bradycardia or tachycardia for clinical setting or age); cardiac specific symptoms or high risk group (elderly patients with known cardiovascular disease or risk factors for cardiovascular disease). All patients had EKG registration and troponin I levels determined. We collated demographic, clinical, laboratory, treatment, and outcome data. The association between categorical variables was analyzed by the chi squared test and Fisher exact test using R software version A P value of <.0.05 was significant in all analyses.
REFERENCES
¹ Fisher Exact Test.
Legend:
CAT – Coronary Catheterization
Cardiac MR – Cardiac Magnetic Resonance
EF – Ejection Fraction
HTN - Hypertension
DM – Diabetes Mellitus
CAD – Coronary Artery Disease
Shivanthan MC, Navinan MR, Constantine GR, Rajapakse S. Cardiac involvement in dengue infection. J Infect dev Ctries 2015; 9(4): doi: /jidc.6200
Lee IK, Lee WH, Liu JW, Yang KD. Acute myocarditis in dengue hemorrhagic fever: a case report and review of cardiac complications in dengue-affected patients. J Infect Dis 2010; 14: doi: /j.ijid
Yacoub S, Wertheim H, Simmons CP, Screaton G, Wills B. Cardiovascular manifestations of the emerging dengue pandemic. Nat Rev Cardiol 2014; 11: doi: /nrcardio
Table 1 – Factors influencing risk of death in univariate analysis.