Issop Azizah, Bertolotti Antoine, Diarra Yves-Marie, Maïza Jean-Christophe, Jarlet Éric, Cogne Muriel, Doussiet Éric, Magny Éric, Maillard Olivier, Nobécourt Estelle, Gérardin Patrick
Service d'Endocrinologie et Diabétologie, Centre Hospitalier Universitaire Réunion, Saint Pierre, La Réunion, France.
INSERM, CIC 1410, Centre Hospitalier Universitaire Réunion, Saint-Pierre, La Réunion, France; Service des Maladies Infectieuses, Médecine Interne, Dermatologie, Centre Hospitalier Universitaire Réunion, Saint Pierre, La Réunion, France.
Travel Med Infect Dis. 2023 Jul-Aug;54:102586. doi: 10.1016/j.tmaid.2023.102586. Epub 2023 Jun 5.
Diabetes mellitus is associated with both the risks of severe dengue and dengue-related deaths, however the factors characterizing dengue in the diabetic patient are ill-recognized. The objective of this hospital-based cohort study was to identify the factors characterizing dengue and those able to early identify dengue severity in the diabetic patient.
We retrospectively analysed demographic, clinical and biological parameters at admission in the cohort of patients who consulted at the university hospital between January and June 2019 with confirmed dengue. Bivariate and multivariate analyses were conducted.
Of 936 patients, 184 patients (20%) were diabetic. One hundred and eighty-eight patients (20%) developed severe dengue according to the WHO 2009 definition. Diabetic patients were older and had more comorbidities than non-diabetics. In an age-adjusted logistic regression model, loss of appetite, altered mental status, high neutrophil to platelet ratios (>14.7), low haematocrit (≤ 38%), upper-range serum creatinine (>100 µmol/l) and high urea to creatinine ratio (>50) were indicative of dengue in the diabetic patient. A modified Poisson regression model identified four key independent harbingers of severe dengue in the diabetic patient: presence of diabetes complications, non-severe bleeding, altered mental status and cough. Among diabetes complications, diabetic retinopathy and neuropathy, but not diabetic nephropathy nor diabetic foot, were associated with severe dengue.
At hospital first presentation, dengue in the diabetic patient is characterized by deteriorations in appetite, mental and renal functioning, while severe dengue can be early identified by presence of diabetes complications, dengue-related non-severe haemorrhages, cough, and dengue-related encephalopathy.
糖尿病与严重登革热风险及登革热相关死亡均有关联，但糖尿病患者登革热的特征因素尚未得到充分认识。这项基于医院的队列研究旨在确定糖尿病患者登革热的特征因素以及能够早期识别登革热严重程度的因素。
我们回顾性分析了2019年1月至6月期间在大学医院就诊且确诊为登革热的患者队列入院时的人口统计学、临床和生物学参数。进行了双变量和多变量分析。
在936名患者中，184名患者（20%）患有糖尿病。根据世界卫生组织2009年的定义，188名患者（20%）发生了严重登革热。糖尿病患者比非糖尿病患者年龄更大，合并症更多。在年龄校正的逻辑回归模型中，食欲减退、精神状态改变、高中性粒细胞与血小板比值（>14.7）、低血细胞比容（≤38%）、血清肌酐上限（>100µmol/l）和高尿素与肌酐比值（>50）表明糖尿病患者患有登革热。改良泊松回归模型确定了糖尿病患者严重登革热的四个关键独立预兆：糖尿病并发症的存在、非严重出血、精神状态改变和咳嗽。在糖尿病并发症中，糖尿病视网膜病变和神经病变与严重登革热有关，而糖尿病肾病和糖尿病足则无关。
在医院首次就诊时，糖尿病患者的登革热表现为食欲、精神和肾功能恶化，而严重登革热可通过糖尿病并发症、登革热相关非严重出血、咳嗽和登革热相关脑病的存在早期识别。
