Study Of Dengue Patients with Dengue Fever for Its Association of Hypocalcemia and Disease Severity

Background: Dengue is a major public health problem in endemic regions, with clinical presentations ranging from mild febrile illness to severe life-threatening syndromes. Biochemical abnormalities, particularly hypocalcemia, have been increasingly recognized as potential predictors of disease severity.

Methods: This observational study was conducted at Victoria Hospital, Bangalore Medical College, Bangalore, from July to December 2023. A total of 120 seropositive dengue patients aged ≥18 years were included after obtaining informed consent. Patients with other acute infections causing hypocalcemia or pre-existing calcium deficiency disorders were excluded. Demographic, clinical, and laboratory data were collected. Serum calcium levels were measured and patients were categorized as normocalcemic or hypocalcemic. Hypocalcemia was graded as mild, moderate, or severe. Disease severity was classified into dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS) based on WHO criteria.

Results: Among 120 patients, the majority were aged 18–40 years (66.7%), with a male predominance (63.3%). DF was the most common presentation (70.0%), followed by DHF (23.3%) and DSS (6.7%). Hypocalcemia was detected in 36.7% of patients, with mild hypocalcemia being the most frequent (45.5%). A strong correlation was observed between calcium levels and disease severity: 71.4% of DF patients had normal calcium, compared to 50.0% in DHF and only 25.0% in DSS. Notably, 75.0% of DSS patients exhibited hypocalcemia. Thrombocytopenia was frequent, with most inpatients (82.4%) requiring platelet transfusions. The mean duration of hospital stay was longer in patients with hypocalcemia. Overall mortality was 3.3%, occurring exclusively in severe cases (DHF/DSS).

Conclusion: A significant proportion of dengue patients in our study exhibited hypocalcemia, which correlated strongly with disease severity. Monitoring serum calcium levels may provide a simple, cost-effective tool for early identification of patients at risk of severe disease. Early interventions could potentially reduce morbidity and mortality. Larger multicenter studies are warranted to validate these findings.