{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T14:33:40Z","timestamp":1786113220433,"version":"build-2736575974"},"update-to":[{"DOI":"10.1371\/journal.pntd.0013729","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000}}],"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UGC-RGC GRF Hong Kong","award":["17111124"],"award-info":[{"award-number":["17111124"]}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dengue fever, caused by the dengue virus (DENV), remains a major public health threat in tropical and subtropical regions. Bangladesh recoded its largest dengue outbreak in 2023. Understanding factors associated with dengue severity is essential to improve clinical triage and outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a hospital-based study of 466 laboratory-confirmed dengue cases admitted to four tertiary hospitals in Dhaka during the peak epidemic period (September 1 to October 31, 2023). Demographic, clinical, and laboratory data were collected using a semi-structured questionnaire. Cases were categorized based on severity, and multivariable models were used to identify factors associated with severe dengue.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Severe dengue was independently associated with older age (adjusted OR [aOR] 2.381, 95% confidence interval [CI] 2.378\u20132.385) and higher pulse rate (aOR 1.035, 95% CI 1.034\u20131.037). After adjustment, higher BMI showed a protective association with severe dengue (aOR 0.094, 95% CI 0.094\u20130.094,). Higher platelet count (aOR 0.834, 95% CI 0.832\u20130.835), hematocrit (aOR 0.010, 95% CI 0.010\u20130.010), white blood cell (WBC) count (aOR 0.594, 95% CI 0.593\u20130.595), and body temperature (aOR 0.543, 95% CI 0.542\u20130.544) were also associated with reduced odds of severe outcomes. Delays in seeking care were associated with increased severity (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007). Symptom-based markers, such as abdominal pain (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and respiratory distress (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013), were strong predictors of severe dengue.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Risk of severe dengue was driven by demographic and clinical features, and was exacerbated by delayed presentation. The observed association involving BMI warrants further study. These findings may support targeted, timely clinical management during outbreaks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0013729","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:46:51Z","timestamp":1785433611000},"page":"e0013729","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and haematological correlates of severe dengue using 2023 epidemic data: A multicentre tertiary hospital-based analysis from Dhaka, Bangladesh"],"prefix":"10.1371","volume":"20","author":[{"given":"M. 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Daily Dengue Status Report [31\/12\/2023]. https:\/\/old.dghs.gov.bd\/index.php\/en\/data"},{"key":"pntd.0013729.ref004","unstructured":"World Health Organization. Dengue: guidelines for diagnosis, treatment, prevention and control: Department of Control of Neglected Tropical Diseases, WHO; 2009."},{"key":"pntd.0013729.ref005","doi-asserted-by":"crossref","first-page":"102855","DOI":"10.1016\/j.tmaid.2025.102855","article-title":"Prognosis and mortality risk in elderly patients with dengue virus infection: Excess fatality and the urgent need for revising current WHO criteria for elderly patients","volume":"65","author":"M-J Jeng","year":"2025","journal-title":"Travel Medicine and Infectious Disease"},{"issue":"5","key":"pntd.0013729.ref006","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0001641","article-title":"Diabetes with hypertension as risk factors for adult dengue hemorrhagic fever in a predominantly dengue serotype 2 epidemic: a case control study","volume":"6","author":"J Pang","year":"2012","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0013729.ref007","doi-asserted-by":"crossref","first-page":"39872","DOI":"10.1038\/srep39872","article-title":"Diabetes, cardiac disorders and asthma as risk factors for severe organ involvement among adult dengue patients: A matched case-control study","volume":"7","author":"J Pang","year":"2017","journal-title":"Sci Rep"},{"issue":"1","key":"pntd.0013729.ref008","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.jointm.2023.07.007","article-title":"Severe dengue in the intensive care unit","volume":"4","author":"AM Tejo","year":"2023","journal-title":"J Intensive Med"},{"issue":"10","key":"pntd.0013729.ref009","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0005050","article-title":"Factors Associated with the Time of Admission among Notified Dengue Fever Cases in Region VIII Philippines from 2008 to 2014","volume":"10","author":"JE Abello","year":"2016","journal-title":"PLOS Neglected Tropical Diseases"},{"issue":"2","key":"pntd.0013729.ref010","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006263","article-title":"The association between obesity and dengue severity among pediatric patients: A systematic review and meta-analysis","volume":"12","author":"MS Zulkipli","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pntd.0013729.ref011","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1186\/s12879-023-08481-9","article-title":"Obesity as a clinical predictor for severe manifestation of dengue: a systematic review and meta-analysis","volume":"23","author":"C-Y Chen","year":"2023","journal-title":"BMC Infect Dis"},{"issue":"2","key":"pntd.0013729.ref012","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.jmii.2022.08.008","article-title":"The association of obesity and dengue severity in hospitalized adult patients","volume":"56","author":"Y-Y Chiu","year":"2023","journal-title":"J Microbiol Immunol Infect"},{"issue":"9300","key":"pntd.0013729.ref013","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S0140-6736(02)07283-5","article-title":"An overview of clinical research: the lay of the land","volume":"359","author":"DA Grimes","year":"2002","journal-title":"Lancet"},{"key":"pntd.0013729.ref014","unstructured":"Directorate General of Health Services. National Guideline for Clinical Management of Dengue Syndrome. 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