Clinical Features Of Dengue Fever With Pleural Effusion And Its Risk Factors

Background:Dengue fever(DF)is an acute infectious disease caused by the dengue virus,and can be classified as DF or severe dengue(SD).Its primary clinical manifestations include fever,headache,muscle and joint pain,nausea,and vomiting.SD mainly manifests as severe bleeding,shock,and organ damage,and has a high mortality rate.One of the areas of organ damage are the lungs,with manifestations including pneumonia,pleural effusion,pulmonary hemorrhage,and acute respiratory distress syndrome.Although the proportion of patients with lung involvement was low,the lung changes are important in severe cases.Currently,studies related to dengue lung disease are few,which are mostly case reports,and no reports of dengue combined with early pleural effusion in China have been published.In this multicenter study,the chest imaging findings of dengue and the dynamic changes in the imaging findings of the chest with severe dengue were observed.The clinical features of DF combined with early pleural effusion were analyzed,and the pleural effusion volume of patients with dengue were quantitatively analyzed using artificial intelligence(AI)to enhance clinicians’ understanding of dengue combined with lung changes.Objective:To explore the characteristics of dengue fever complicated with pleural effusion and improve the level of diagnosis and treatment.Methods:1.A total of 395 patients with dengue with abnormal chest imaging findings from2013 to 2019 were collected,and plain chest X-ray and/or chest computed tomography were performed to analyze the chest imaging findings.2.Two hundred and sixty one patients with dengue fever were included,with 171 cases in the pleural effusion group and 90 cases in the control group.The clinical manifestations,laboratory indicators,and imaging examinations of the two groups were compared and the risk factors of dengue combined with pleural effusion were analyzed using multivariate regression.3.Thirty One patients with dengue fever were included,with 20 cases of DF and11 cases of SD.Using AI,the volume of pleural effusion was quantitatively analyzed between both groups.Results:1.Analyzing 395 cases of dengue fever with abnormal chest changes,the predominant abnormal chest imaging manifestations of dengue fever were pleural effusion,ground-glass opacity,pulmonary consolidation,thickening of the interlobular septa,and thickening of the peribronchovascular interstitium.The proportion of pleural effusion and pulmonary consolidation in the severe dengue group was higher than that in the ordinary dengue group(P<0.05).SD chest imaging demonstrates the process of gradual absorption of lesions or simple progression from a few lesions to many lesions,mixed existence,and finally gradual absorption and dissipation.2.The 261 patients with dengue fever were divided into 90 cases in the pleural effusion group and 171 cases in the control group.Among the 90 patients in the pleural effusion group,49 cases(54.44%)had bilateral pleural effusions,29 cases(32.22%)had unilateral right sided effusion,and 12 cases(13.33%)had unilateral left sided effusion.Eighty-seven(96.67%)patients had mild pleural effusion,thre e(3.33%)had moderate pleural effusion,while no patients had massive pleural effusion.No significant differences in age and gender was observed between the two groups.The proportion of patients with diabetes,coronary heart disease,and chronic obstructive pulmonary disease was higher in the dengue fever combined with pleural effusion group than in the control group(P<0.05).The incidence of severe disease in patients with dengue fever and pleural effusion was significantly higher than that in patients without pleural effusion(27.78% vs.9.36%)(P<0.001).Further,the length of hospital stay was significantly longer in the dengue fever with pleural effusion group than that in the group without pleural effusion [7(5,10)d vs.6(4,8)d,P<0.001].Among the 261 patients with dengue fever,the incidence of muscle pain and persistent vomiting in the pleural effusion group was higher than that in the group without pleural effusion(P<0.05).The platelet count and serum albumin levels were decreased in the pleural effusion group(P<0.05),whereas the aspartate aminotransferase,lactate dehydrogenase,C-reactive protein and procalcitonin levels were elevated in the pleural effusion group(P<0.05).Nine patients(3.45%)had pulmonary consolidation,and the incidence of pulmonary consolidation with pleural effusion was significantly higher than that without pleural effusion(7.78% vs.1.17%,P<0.05).Moreover,the effusion was exudative.The multivariate regression analysis suggested chronic obstructive pulmonary disease(OR=0.065,95% CI: 0.006,0.686,P=0.023),persistent vomiting(OR=0.213,95% CI: 0.074,0.614,P=0.004),decreased platelet count(OR=0.993,95% CI: 0.986,0.999,P=0.035),and decreased serum albumin levels(OR=0.886,95% CI: 0.806,0.973,P=0.012)as independent risk factors for dengue fever and pleural effusion.3.The volume of the pleural effusion in SD was significantly larger than that of the pleural effusion in DF[24.00(15.29,47.88)m L vs.8.97(3.53,28.41)m L,P<0.05].Conclusions:1.Chest imaging in patients with dengue is dominated by pleural effusion and parenchymal lung lesions.2.Early pleural effusions in patients with dengue are characterized by small amounts of effusion and are mostly bilateral.Persistent vomiting,chronic obstructive pulmonary disease,low platelet count,and low serum albumin levels are independent risk factors for denguefever with pleural effusion.3.AI can be used to analyze pleural effusion in patients with dengue fever.