Clinical and laboratory factors associated with dengue with warning signs and/or severe dengue in hospitalized patients at a public healthcare institution in Mexico.

Abstract

Background: The increase in dengue cases in areas with fluctuating endemicity patterns requires the strengthening of clinical assessment in hospitals. Aim: To identify admission-time clinical and laboratory variables of dengue with warning signs and/or severe dengue. Materials and Methods: An observational, analytical, and cross-sectional study based on a review of electronic records, conducted at a public hospital in Querétaro, Mexico between January and December 2024. The study included 242 patients with dengue confirmed by NS1 using ELISA. The composite outcome of dengue with warning signs and/or severe dengue (n=59) was compared with dengue without warning signs (n=183). Pearson’s χ², Fisher’s exact test, and binary logistic regression were used. Results: In the bivariate analysis, retroorbital pain, general malaise, nausea/vomiting, and low hemoglobin were associated with the composite outcome; elevated hematocrit was observed only in the group with warning signs and/or severe dengue. After multivariate adjustment, retroorbital pain (aOR 2.13), general malaise (aOR 3.31), and nausea/vomiting (aOR 2.98) remained associated. Discussion: The findings represent exploratory associations on admission and not a validated predictive rule. Conclusions: These clinical features may complement clinical surveillance without replacing the 2009 WHO classification