Hypoalbuminemia as a predictor of severe dengue: a systematic review and meta-analysis.

Mahalaqua Nazli Khatib, Hussain R Alturaifi, Tahani Alrahbeni, Khalid Al-Mugheed, Neelima Kukreti, Muhammed Shabil, Ganesh Bushi, Prakasini Satapathy, Ali A Rabaan, Quazi Syed Zahiruddin, Vasso Apostolopoulos, Sarvesh Rustagi, Faryal Khamis, Yousef N Alhashem, Tarek Sulaiman, Nawal A Al Kaabi, Jawaher Alotaibi, Shilpa Gaidhane

Journal: Expert review of anti-infective therapy 2025;23(1):105-118

PMID: 39745180

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Abstract

INTRODUCTION

Dengue fever is a significant health concern globally, especially in tropical regions. Identifying reliable markers for severe dengue, such as hypoalbuminemia, is crucial for early diagnosis and treatment.

METHODS

This review systematically explores the association between hypoalbuminemia and severe dengue. We searched databases including PubMed, Embase, Scopus, Cochrane, and Web of Science until 28 December 2023, focusing on studies that reported albumin levels in dengue patients. Our selection criteria aimed at observational studies, from which data extraction and quality assessment were performed using Nested- Knowledge and the Newcastle-Ottawa Scale.

RESULTS

A meta-analysis of 17 studies involving 974 severe and 18,496 non-severe dengue patients identified a standardized mean difference (SMD) in albumin levels of -1.625 g/dL (95% CI: -3.618 to -0.369). Subgroup analysis indicated more pronounced hypoalbuminemia in pediatric patients, with a pooled SMD of -1.08 g/dL (95% CI: -1.71 to -0.45). Our analysis demonstrated the link between hypoalbuminemia and severe dengue, indicating a significant pooled relative risk of 2.286, within 95% CI 1.308 to 3.996.

CONCLUSIONS

The study confirms hypoalbuminemia as a significant predictor of severe dengue. Recognizing hypoalbuminemia in dengue patients can aid clinicians in forecasting the severity, potentially improving patient outcomes through targeted therapeutic strategies.

Address: University Center for Research and Development, Chandigarh University, Mohali, India.; School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India.; School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.; Molecular Toxicology and Genetics, Riyadh Elm University, Riyadh, Saudi Arabia.; Adult Health Nursing and Critical Care, Riyadh Elm University, Riyadh, Saudi Arabia.; Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India.; One Health Centre (COHERD), Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India.; Global South Asia Infant Feeding Research Network (SAIFRN), Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India.; School of Pharmacy, Graphic Era Hill University, Dehradun, India.; Graphic Era (Deemed to be University), Dehradun, India.; School of Applied and Life Sciences, Uttaranchal University, Dehradun, India.; Clinical Laboratory Science Department, Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia.; Infectious diseases Unit, Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.; College of Medicine and Health Science, Khalifa University, Abu Dhabi, United Arab Emirates.; Sheikh Khalifa Medical City, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, United Arab Emirates.; Infectious Diseases Section, Medical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia.; Department of Laboratory and Blood Bank, King Fahad Hospital, Al Hofuf, Saudi Arabia.; Infection Diseases unit, Department of Internal Medicine, Royal Hospital, Muscat, Oman.; Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.; Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan.; Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.; Medical Laboratories Techniques Department, AL-Mustaqbal University, Hillah, Babil, Iraq.

DOI: 10.1080/14787210.2024.2448721

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MeSH Terms: Child, Humans, Biomarkers, Dengue, Early Diagnosis, Hypoalbuminemia, Observational Studies as Topic, Severe Dengue, Severity of Illness Index