Rehman Fazal U, Omair Syed Furrukh, Memon Fatima, Amin Imrana, Rind Bakhtawar J, Aziz Sumera
Medicine, Aga Khan University Hospital, Karachi, PAK.
Internal Medicine, Dow University of Health Sciences, Karachi, PAK.
Cureus. 2020 Sep 13;12(9):e10419. doi: 10.7759/cureus.10419.
Background A pattern of both clinical and biochemical abnormalities is associated with dengue virus infection (DVI). Among the various DVI-related biochemical defects, electrolyte imbalance is one that can alter the morbidity and mortality among patients. However, there is a dearth of evidence to assess the relationship between electrolyte imbalance and the length of stay or mortality in dengue-infected patients in Pakistan. In the current study, we aimed to investigate the association between electrolyte imbalance at the time of admission and the length of stay and mortality among dengue-infected patients. Methods We conducted a retrospective study at a large tertiary care hospital from November 2018 to November 2019. All patients with known chronic diseases and coinfections or those who were taking diuretics therapies or angiotensin-converting enzyme inhibitors were excluded. Our main exposure of interest was electrolytes imbalance and the outcome measure was the length of stay and mortality. Results A total of 1,008 dengue patients were enrolled with a mean length of stay of 2.56 days. Around 29.3% had hyponatremia and 23.2% had hypokalemia at the time of admission, and 21.9% of patients had a stay beyond three days. In multivariable analysis, hyponatremia [adjusted odds ratios (aOR) = 1.29; 95% confidence interval (CI): 0.59-2.84] and hypokalemia (aOR = 2.36; 95% CI: 0.91-6.10) were not found to be associated with the length of stay. However, patients with high troponin levels at admission had a prolonged stay beyond three days (aOR = 5.74; 95% CI: 2.34-14.11). There was a statistically significant association of creatinine levels (aOR = 14.74; 95% CI: 4.19-15.85) and diabetes mellitus (DM) (aOR = 4.36; 95% CI: 1.21-15.74) with mortality after controlling for potential confounders. Conclusion Electrolyte imbalance at admission is not a predictor of length of stay or fatalities in the hospital among patients with DVI. However, troponin levels at admission can increase hospitalization days whereas DM and renal injury have been found to worsen mortality rates.
临床和生化异常模式与登革病毒感染（DVI）相关。在各种与DVI相关的生化缺陷中，电解质失衡是一种可改变患者发病率和死亡率的因素。然而，在巴基斯坦，缺乏证据来评估登革热感染患者电解质失衡与住院时间或死亡率之间的关系。在本研究中，我们旨在调查登革热感染患者入院时电解质失衡与住院时间和死亡率之间的关联。
我们于2018年11月至2019年11月在一家大型三级护理医院进行了一项回顾性研究。所有患有已知慢性病和合并感染的患者，或正在接受利尿剂治疗或血管紧张素转换酶抑制剂治疗的患者均被排除。我们主要关注的暴露因素是电解质失衡，结果指标是住院时间和死亡率。
共纳入1008例登革热患者，平均住院时间为2.56天。入院时约29.3%的患者有低钠血症，23.2%的患者有低钾血症，21.9%的患者住院时间超过三天。在多变量分析中，未发现低钠血症[调整后的优势比（aOR）=1.29；95%置信区间（CI）：0.59 - 2.84]和低钾血症（aOR = 2.36；95% CI：0.91 - 6.10）与住院时间相关。然而，入院时肌钙蛋白水平高的患者住院时间超过三天（aOR = 5.74；95% CI：2.34 - 14.11）。在控制潜在混杂因素后，肌酐水平（aOR = 14.74；95% CI：4.19 - 15.85）和糖尿病（DM）（aOR = 4.36；95% CI：1.21 - 15.74）与死亡率存在统计学显著关联。
入院时的电解质失衡不是DVI患者住院时间或医院内死亡的预测因素。然而，入院时的肌钙蛋白水平可增加住院天数，而DM和肾损伤已被发现会使死亡率恶化。
