{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T05:33:37Z","timestamp":1777872817339,"version":"3.51.4"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Dengue fever represents a major global health burden with hepatic involvement occurring in up to 90% of hospitalized patients. This study aimed to determine in-hospital mortality predictors, characterize clinical outcomes across graded hepatic injury phenotypes, and validate prognostic scoring systems in hospitalized dengue patients. A primary focus was assessing the impact of pre-existing liver conditions on disease trajectory and survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort analysis was conducted on 1,484 patients with laboratory-confirmed dengue infection admitted to a tertiary-care center between 2021 and 2024. Patients were stratified by hepatic status into those with pre-existing chronic liver disease, non-chronic steatotic liver involvement, and no liver involvement. Multivariable logistic regression identified independent mortality predictors, while unsupervised clustering distinguished clinical phenotypes. The performance of physiological and liver-specific prognostic scores was evaluated against clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The overall in-hospital mortality rate was 5.1%, with 13.1% requiring intensive care admission. Independent predictors of mortality included severe dengue classification, intensive care unit admission, elevated neutrophil-to-lymphocyte ratio, and hypoalbuminemia, with albumin emerging as the strongest single biomarker for risk prediction. Paradoxically, patients with steatotic liver disease demonstrated improved survival compared to those without pre-existing liver disease, supporting an \u201cobesity paradox\u201d in this tropical infection context, whereas decompensated cirrhosis was associated with markedly adverse outcomes. The Albumin-Bilirubin grade successfully stratified hepatic risk, and the Simplified Acute Physiology Score-3 significantly outperformed the Sequential Organ Failure Assessment for predicting mortality in critically ill patients. Four distinct clinical phenotypes with differential mortality ranging from 3.0% to 100% were identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Hypoalbuminemia serves as a critical, accessible prognostic marker in dengue fever. Pre-existing liver pathology demonstrates divergent impacts on outcomes, with steatotic liver disease potentially conferring survival advantage contrary to traditional metabolic risk assumptions. These findings support the utility of liver-specific scoring systems for acute risk stratification in dengue-endemic regions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0348232","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T17:45:38Z","timestamp":1777571138000},"page":"e0348232","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mortality predictors, hepatic involvement patterns, and the steatotic liver paradox in 1,484 hospitalized Dengue patients"],"prefix":"10.1371","volume":"21","author":[{"given":"Aryalakshmi","family":"Sreemohan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arif Hussain","family":"Theruvath","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ambily","family":"Baby","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9587-336X","authenticated-orcid":true,"given":"Cyriac Abby","family":"Philips","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tharun Tom","family":"Oommen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Santhichandra","family":"Pai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salini Baby","family":"John","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaicob","family":"Varghese","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rizwan","family":"Ahamed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajit","family":"Tharakan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Augustine","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"issue":"1","key":"pone.0348232.ref001","doi-asserted-by":"crossref","first-page":"3418","DOI":"10.1038\/s41467-025-58609-5","article-title":"The overlapping global distribution of dengue, chikungunya, Zika and yellow fever","volume":"16","author":"A Lim","year":"2025","journal-title":"Nat Commun"},{"key":"pone.0348232.ref002","unstructured":"World Health Organization. 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