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Original Article

Metabolic and cardiovascular comorbidities as predictors of severe dengue in Vietnamese adults: a retrospective study, 2022–2024

Thang Nhu Doan1,2orcid, Duc Minh Cap3orcid
Osong Public Health and Research Perspectives 2026;17(2):136-144.
Published online: March 19, 2026

1Department of Family Medicine, Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam

2Department of Human Resources, Haiphong Medical University Hospital, Haiphong, Vietnam

3Faculty of Public Health, Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam

Corresponding author: Duc Minh Cap Faculty of Public Health, Haiphong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem street, Gia Vien ward, Haiphong City, Vietnam E-mail: cmduc@hpmu.edu.vn
• Received: August 10, 2025   • Revised: January 29, 2026   • Accepted: February 6, 2026

© 2026 Korea Disease Control and Prevention Agency.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • Objectives
    This study aimed to determine the prevalence of severe dengue and examine the associations between pre-existing comorbidities and disease severity.
  • Methods
    This retrospective study examined patients with dengue fever who received inpatient treatment at a hospital in northern Vietnam between January 1, 2022, and December 30, 2024. Patients were categorized into 2 groups—severe dengue and non-severe dengue—based on the 2009 World Health Organization criteria. Multivariable logistic regression was performed to assess factors associated with severe dengue.
  • Results
    Among 3,692 patients, the prevalence of severe dengue was 1.5%. Patients with any pre-existing comorbidity had higher odds of severe dengue compared to those without comorbidities (adjusted odds ratio [aOR], 2.06; 95% confidence interval [CI], 1.20–3.53). Having 2 or more comorbidities was also associated with higher odds of severe dengue (aOR, 2.26; 95% CI, 1.18–4.33). Among individual conditions, hyperlipidemia was associated with severe dengue (aOR, 2.32; 95% CI, 1.17–4.81). Certain combinations of comorbidities, including hypertension with hyperlipidemia (aOR, 2.88; 95% CI, 1.39–5.97), hypertension with cardiac disease (aOR, 4.39; 95% CI, 1.30–14.79), and hyperlipidemia with cardiac disease (aOR, 4.02; 95% CI, 1.19–13.53), were also associated with higher odds of severe dengue.
  • Conclusion
    Pre-existing comorbidities, particularly cardiometabolic conditions, were associated with higher odds of severe dengue. Considering comorbidity profiles at hospital admission may help identify patients who require closer clinical monitoring.
  • Keywords: Dengue; Severe dengue; Vietnam
Dengue fever is an acute infectious disease caused by the dengue virus and is primarily transmitted by Aedes mosquitoes. It is prevalent in tropical and subtropical regions [1]. In recent years, dengue outbreaks have increased, becoming a serious global public health concern. The number of reported cases increased from over 500,000 in 2000 to more than 6.5 million in 2023 [2,3]. In Vietnam, dengue fever exhibits seasonal patterns with unpredictable fluctuations, typically peaking during the rainy months from June to October each year. The incidence rate per 100,000 population increased from 120 in 2009 (105,370 cases) to 194 in 2017 (184,000 cases) [4].
In 2009, the World Health Organization (WHO) introduced a new classification system for dengue cases, replacing the previous terms “dengue fever” and “dengue shock syndrome” with the categories “dengue with or without warning signs” and “severe dengue” [5]. Severe dengue is characterized by significant plasma leakage leading to shock and/or fluid accumulation with respiratory distress; severe bleeding; and severe organ involvement, including hepatic, renal, neurological, and cardiovascular dysfunction [5]. While most symptomatic cases range from mild to moderate, approximately 5% of patients may progress to severe disease [6].
Numerous studies have demonstrated that pre-existing comorbidities—such as diabetes [7–9], hypertension [8–10], cardiovascular disease [7–9], chronic kidney disease [7,9,11], obesity [8,12], and chronic respiratory disease [7,9,11]—are associated with a higher risk of severe dengue. Individuals with these conditions are more likely to require hospitalization and have a higher risk of complications, longer treatment duration, and increased mortality [7,9,11]. Notably, patients with 2 or more comorbidities may face a 2- to 3-fold increased risk of severe dengue [7,11]. The underlying mechanisms are thought to involve immune dysregulation, endothelial dysfunction, and multi-organ injury. A weakened or dysregulated immune response reduces the body’s ability to control the dengue virus, leading to inefficient viral clearance and an increased risk of progression to severe dengue [13,14]. Dengue infection also causes vascular endothelial dysfunction, increasing vascular permeability and resulting in plasma leakage—the fundamental mechanism underlying dengue shock syndrome. This process may be exacerbated in patients with pre-existing endothelial damage due to hypertension, diabetes, or cardiovascular disease [15–17]. In addition, the dengue virus can affect multiple organs, including the heart, kidneys, liver, and nervous system—particularly in individuals with pre-existing chronic conditions—thereby increasing the risk of severe complications and mortality [6].
Objectives
In Vietnam, data on the impact of pre-existing comorbidities on severe dengue in adults remain limited. Therefore, this study was conducted to determine the prevalence of severe dengue and to examine the association between pre-existing comorbidities and severe dengue among hospitalized adults in northern Vietnam from 2022 to 2024. The findings may provide useful evidence to support clinical risk assessment and severity stratification at hospital admission.
Study Design and Setting
This retrospective study included patients diagnosed with dengue who were hospitalized at Haiphong Medical University Hospital, a 300-bed healthcare facility in northern Vietnam, approximately 120 km from Hanoi, the capital city.
Participants
Inclusion criteria: Eligible participants were adults aged 18 years and older who presented with fever and at least 2 clinical signs or symptoms suggestive of dengue, such as nausea/vomiting, skin rash, musculoskeletal pain, or a positive tourniquet test, or who tested positive by at least 1 diagnostic method, according to the 2009 WHO guidelines. Exclusion criteria: Patients with incomplete data on demographics, comorbidities, clinical manifestations, or laboratory findings were excluded. Between January 2022 and December 2024, 3,692 patients met the inclusion criteria and were included in the final analysis.
Data Collection Form
Data were extracted from the hospital management software using a pre-designed data collection form. The extraction was performed by an information technology engineer who had received basic training in medical data to support accurate interpretation and handling of clinical information. To verify the accuracy of the extracted data, 10% of cases were randomly selected and cross-checked against the corresponding paper-based medical records. This validation step was performed to ensure the reliability and consistency of the collected data. The data collection form consisted of 3 sections.

Demographic characteristics

Sex (male or female), age (years), place of residence (urban or suburban), weight (kg), height (cm), and length of hospital stay (days). Nutritional status was classified as “non-overweight/obese” (including underweight and normal weight; body mass index [BMI] <23 kg/m2) or “overweight/obese” (BMI ≥23 kg/m2) [18].

Pre-existing comorbidities

Hypertension, hyperlipidemia, diabetes, lung disease, liver disease, kidney disease, cardiac disease, heart failure, and asthma. Based on a previous study, lung disease included pleural effusion, bronchitis, pneumonia, pulmonary tuberculosis, and chronic obstructive pulmonary disease. Liver disease included viral hepatitis, cirrhosis, acute hepatitis, acute liver failure, and fatty liver disease. Kidney disease included chronic kidney disease, kidney stones, glomerulonephritis, and other renal conditions. Cardiac disease included ischemic heart disease, myocardial infarction, ventricular extrasystoles, and other heart conditions, excluding heart failure and peripheral vascular disease [7].

Clinical manifestations and laboratory features

All symptoms and test results were recorded at hospital admission. Laboratory parameters included red blood cell count (×1012/L), platelet count (×109/L), white blood cell count (×109/L), hemoglobin (g/L), hematocrit (%), aspartate aminotransferase (AST; U/L), and alanine aminotransferase (ALT; U/L). Hematological tests were performed using the DxH 690T analyzer (Beckman Coulter), and biochemical tests were conducted with the AU480 chemistry analyzer (Beckman Coulter).
Dengue Diagnosis and Severity
All collected plasma samples were tested for dengue nonstructural protein 1 (NS1) antigen using the BIOLINE Dengue Duo rapid diagnostic test (Abbott Diagnostics Korea Inc.). Anti-dengue virus (DENV) immunoglobulin M (Ig) M and IgG antibodies were detected using enzyme-linked immunosorbent assay (ELISA). Dengue was diagnosed based on clinical criteria consistent with the 2009 WHO guidelines and was confirmed by either a positive NS1 antigen result during the early febrile phase (days 1–5 of illness) or IgM/IgG antibody detection by ELISA from day 5 onward [5].
Severe dengue was diagnosed when at least 1 of the following criteria was present: plasma leakage (clinical fluid accumulation or a hematocrit increase of ≥20%) accompanied by shock—defined by at least 1 of the following signs: tachycardia (heart rate >100 beats/min), hypotension (systolic blood pressure <90 mmHg), or narrow pulse pressure (<20 mmHg)—or respiratory distress; severe bleeding defined as WHO grade 2 or higher, such as hematemesis, melena, menorrhagia, or clinically significant hemoglobin decrease requiring blood transfusion (whole blood or packed red blood cells); or severe organ involvement, including liver injury (AST or ALT >1,000 IU/L), kidney injury (acute kidney injury stage 2, defined as a ≥100% increase in serum creatinine from baseline), or heart failure [5].
Statistical Methods
Data were extracted from the hospital management software and imported into Excel for Microsoft 365 (Microsoft Corp.), then analyzed using IBM SPSS ver. 25.0 (IBM Corp.). Only patients with complete data for all study variables were included in the analysis. Records with missing information for any variable were excluded, and no data imputation was performed.
Categorical variables were presented as frequencies and percentages. Continuous variables were summarized as mean and standard deviation for normally distributed data or median and interquartile range (IQR) for non-normally distributed data. Variables were compared between the severe and non-severe dengue groups using the chi-square test or Fisher exact test, as appropriate. Between-group differences in continuous variables were assessed using the independent-samples t-test for normally distributed data or the Mann-Whitney U-test for non-normally distributed data.
Univariable logistic regression was performed to estimate crude odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with severe dengue. Multivariable logistic regression models were then fitted to estimate adjusted ORs (aORs). Covariates included in the multivariable models were selected a priori based on clinical relevance and the previous literature. All models were adjusted for key potential confounders, including age group, sex, place of residence, and overweight/obesity status. Potential multicollinearity among covariates was assessed using variance inflation factors. Model fit was evaluated using the Hosmer-Lemeshow goodness-of-fit test. A 2-sided p-value less than 0.05 was considered to indicate statistical significance.
Ethics Statement
The study protocol was approved by the Scientific Committee of Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam (No. 2004/QĐ-YDHP; code: HPMU.ĐTCS.2024.123; dated September 30, 2024) and was authorized by the leadership of Haiphong Medical University Hospital. All data were anonymized and collected retrospectively; therefore, the requirement for informed consent was waived.
The prevalence of severe dengue was 1.5% (56 cases). No significant differences were observed between the severe and non-severe groups in sex, age, place of residence, or overweight/obesity status (all p>0.05). However, patients with severe dengue were more likely to have any pre-existing condition (57.1% vs. 39.4%, p=0.007) and to have 2 or more comorbidities (28.6% vs. 18.1%, p=0.024). Hypertension (28.6% vs. 18.1%, p=0.045), hyperlipidemia (28.6% vs. 13.5%, p=0.001), and cardiac disease (8.9% vs. 3.3%, p=0.022) were significantly more common in the severe group. The length of hospital stay was slightly longer among patients with severe dengue, but the difference was not statistically significant (6.79 days vs. 6.45 days, p=0.289) (Table 1).
All patients presented with fever (100%). Fatigue was significantly less frequent in the severe dengue group (76.8%) than in the non-severe group (90.7%, p<0.001). In contrast, headache (78.6% vs. 63.6%, p=0.020), cough (16.1% vs. 4.8%, p<0.001), skin rash (12.5% vs. 2.9%, p<0.001), pruritic rash (8.9% vs. 2.6%, p=0.004), hemorrhage (12.5% vs. 2.4%, p<0.001), dizziness (5.4% vs. 0.8%, p<0.001), and myalgia (3.6% vs. 0.6%, p=0.004) were significantly more common among severe dengue cases. Regarding laboratory parameters, AST levels were significantly higher in the severe dengue group (median, 48.80 U/L; IQR, 26.80–132.33) than in the non-severe group (median, 33.90 U/L; IQR, 23.63–71.53; p=0.021), suggesting greater hepatic involvement in severe cases. ALT levels were also higher among patients with severe dengue, although this difference was not statistically significant (p=0.058) (Table 2).
Patients with any pre-existing condition had higher odds of severe dengue than those without comorbidities (aOR, 2.06; 95% CI, 1.20–3.53). Patients with 2 or more pre-existing conditions also had higher odds of severe dengue (aOR, 2.26; 95% CI, 1.18–4.33). Among individual comorbidities, hyperlipidemia remained significantly associated with severe dengue (aOR, 2.32; 95% CI, 1.17–4.81). In exploratory analyses, certain combinations of cardiometabolic conditions—hypertension with hyperlipidemia (aOR, 2.88; 95% CI, 1.39–5.97), hypertension with cardiac disease (aOR, 4.39; 95% CI, 1.30–14.79), and hyperlipidemia with cardiac disease (aOR, 4.02; 95% CI, 1.19–13.53)—were also associated with greater odds of severe dengue (Table 3).
This retrospective study, conducted over 3 years (2022–2024) at a hospital in northern Vietnam, found a relatively low prevalence of severe dengue (1.5%). This estimate is lower than that reported in prior studies from tertiary hospitals in Vietnam, including studies conducted in both northern and southern settings [19,20]. It is also lower than figures reported in other Asian outbreaks, such as those in Bangladesh and China [21,22]. Several factors may explain the differences in severe dengue rates across studies. First, local epidemiological characteristics likely play a key role. The rate of severe dengue depends largely on circulating virus serotypes, population immunity, and regional transmission patterns. Areas where less virulent strains predominate or cross-immunity is common often report lower rates of severe dengue complications [23,24]. Second, diagnostic criteria and sampling methods vary. Differences in the definition of “severe dengue,” admission criteria, and diagnostic approaches across studies can substantially influence reported rates. Studies applying stricter criteria or enrolling patients from tertiary referral hospitals often report higher rates of severe dengue [24,25]. Third, healthcare access and early intervention may affect outcomes. Early medical care, greater community awareness, prompt detection, and timely treatment can help reduce the incidence of severe dengue [25,26].
Notably, our findings indicate that patients with pre-existing comorbidities had higher odds of developing severe dengue than those without underlying conditions. Moreover, the likelihood of severe dengue increased with the number of comorbidities, with patients presenting with 2 or more chronic conditions appearing particularly vulnerable. These results are consistent with evidence from systematic reviews and studies across diverse populations, which have identified comorbidities as important factors associated with severe dengue outcomes [7,9,11,27–30].
Among specific conditions, hyperlipidemia remained significantly associated with severe dengue in our study. This association may be partly explained by interactions between dengue infection and host lipid metabolism. Dengue virus replication relies on host lipid pathways, and systemic inflammation and hepatic involvement may further disrupt lipid homeostasis. Prior studies have described characteristic alterations in lipid profiles with increasing dengue severity, suggesting that lipid abnormalities may reflect inflammatory and endothelial changes that contribute to plasma leakage in severe dengue [31,32]. These findings support closer monitoring of patients with dyslipidemia at admission.
Exploratory analyses suggested that certain comorbidity combinations—such as hypertension with hyperlipidemia or cardiac disorders—were associated with higher odds of severe dengue. Similar observations have been reported in other settings, indicating that the burden and clustering of chronic diseases may influence dengue progression [11,24,27]. These associations may reflect shared underlying pathways, including endothelial dysfunction, chronic inflammation, and altered immune responses, which could contribute to plasma leakage and systemic complications during acute infection [14,16,33,34]. However, these findings should be interpreted cautiously, given the limited number of severe dengue cases.
Overall, our findings reinforce current clinical recommendations, highlighting the importance of early risk stratification and close monitoring of patients with dengue and multiple cardiometabolic comorbidities. Targeted attention to these high-risk groups at hospital admission may help optimize management and reduce severe outcomes and dengue-related mortality [35–37].
Strengths and Limitations
This study has several strengths. First, the large sample size enhances the statistical power and reliability of the findings. Second, the use of the 2009 WHO classification criteria for severe and non-severe dengue ensures standardized disease categorization and comparability with other studies. Finally, the findings have clear clinical relevance, as identifying comorbidities associated with severe dengue can support early risk stratification and prioritization of close monitoring for hospitalized patients.
However, several limitations should be acknowledged. First, the retrospective cross-sectional design precludes causal inference regarding the relationship between comorbidities and severe dengue. Second, restricting the analysis to patients with complete data across all variables, without imputation for missing values, may have introduced selection bias. Third, several potential confounders, including smoking, alcohol use, socioeconomic status, and healthcare access, were not collected and therefore could not be adjusted for. Fourth, the study did not assess the severity or degree of control of underlying comorbidities, which may influence clinical outcomes. Finally, because the data were obtained from a single hospital in northern Vietnam, the generalizability of the findings to other settings or healthcare systems may be limited.
The proportion of patients with severe dengue in our study was relatively low. Nevertheless, pre-existing comorbidities were significantly associated with higher odds of severe dengue, particularly among individuals with multiple chronic conditions and those with hyperlipidemia. Exploratory analyses also suggested that certain cardiometabolic comorbidity clusters, such as hypertension combined with hyperlipidemia or cardiac disease, may be associated with increased odds of severe outcomes. These findings highlight the importance of early risk stratification and careful clinical monitoring of patients with dengue and underlying chronic diseases. Greater attention to patients with cardiometabolic comorbidities at admission may facilitate timely recognition of warning signs and supportive management, potentially reducing the risk of complications. In addition, improving awareness among individuals living with chronic conditions about the potential for progression to severe dengue may encourage earlier care-seeking and prompt intervention.
• The prevalence of severe dengue among hospitalized patients at a facility in northern Vietnam was 1.5%.
• The presence of pre-existing comorbidities or 2 or more co-occurring conditions was significantly associated with greater odds of severe dengue.
• Hyperlipidemia and certain combinations of comorbidities (such as hypertension and hyperlipidemia, hypertension and cardiac disease, and hyperlipidemia and cardiac disease) were strongly associated with higher odds of severe dengue.

Ethics Approval

The study protocol was approved by the Scientific Committee of Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam (No. 2004/QĐ-YDHP; code: HPMU.ĐTCS.2024.123; dated September 30, 2024) and was authorized by the leadership of Haiphong Medical University Hospital. All data were anonymized and collected retrospectively; therefore, the requirement for informed consent was waived.

Conflicts of Interest

The authors have no conflicts of interest to declare.

Funding

This study was supported in part by a grant from Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam.

Availability of Data

The datasets are not publicly available but are available from the corresponding author upon reasonable request.

Metabolic and cardiovascular comorbidities as predictors of severe dengue in Vietnamese adults: a retrospective study, 2022–2024
Table 1.
Comparison of demographic characteristics and disease history between severe dengue and non-severe dengue
Table 1.
Characteristic Total (n=3,692) Severe dengue p
Yes (n=56) No (n=3,636)
Sex 0.555
 Male 1,527 (41.4) 21 (37.5) 1,506 (41.4)
 Female 2,165 (58.6) 35 (62.5) 2,130 (58.6)
Age (y) 46.33±16.38 46.07±16.48 46.34±16.38 0.904
 18–30 691 (18.7) 11 (19.6) 680 (18.7) 0.992
 30–39 685 (18.6) 9 (16.1) 676 (18.6)
 40–49 670 (18.1) 10 (17.9) 660 (18.2)
 50–59 623 (16.9) 10 (17.9) 613 (16.9)
 60–78 1,023 (27.7) 16 (28.6) 1,007 (27.7)
Place of residence 0.267
 Urban 3,215 (87.1) 46 (82.1) 3,169 (87.2)
 Suburban 477 (12.9) 10 (17.9) 467 (12.8)
Body mass index (kg/m2) 21.59±1.57 21.78±1.66 21.58±1.56 0.366
Overweight/obesity 0.123
 No 3,110 (84.2) 43 (76.8) 3,067 (84.4)
 Yes 582 (15.8) 13 (23.2) 569 (15.6)
Any pre-existing illness 0.007
 No 2,206 (59.8) 24 (42.9) 2,202 (60.6)
 Yes 1,486 (40.2) 32 (57.1) 1,434 (39.4)
No. of pre-existing illnesses 0.024
 0 2,226 (60.3) 24 (42.8) 2,202 (60.6)
 1 789 (21.4) 16 (28.6) 773 (21.3)
 ≥2 677 (18.3) 16 (28.6) 661 (18.2)
Hypertension 675 (18.3) 16 (28.6) 659 (18.1) 0.045
Hyperlipidemia 506 (13.7) 16 (28.6) 490 (13.5) 0.001
Diabetes 372 (10.1) 5 (8.9) 367 (10.1) 0.774
Lung disease 349 (9.5) 7 (12.5) 342 (9.4) 0.432
Liver disease 204 (5.5) 5 (8.9) 199 (5.5) 0.261a)
Kidney disease 144 (3.9) 1 (1.8) 143 (3.9) 0.410a)
Cardiac disease 126 (3.4) 5 (8.9) 121 (3.3) 0.022a)
Heart failure 21 (0.6) 0 (0) 21 (0.6) NA
Asthma 5 (0.1) 0 (0) 5 (0.1) NA
Length of stay (d) 6.45±2.36 6.79±2.38 6.45±2.36 0.289
 1–3 365 (9.9) 2 (3.6) 363 (10.0) 0.275
 4–6 1,519 (41.1) 24 (42.9) 1,495 (41.1)
 >6 1,808 (49.0) 30 (53.6) 1,778 (48.9)

Data are presented as n (%) or mean±standard deviation. p-values were calculated using the chi-square test or Fisher’s exact test (when ≥25% of expected cell counts were <5) for categorical variables and the Independent-samples t-test for continuous variables.

NA, statistical test not applicable.

a))By Fisher exact test.

Table 2.
Comparison of clinical manifestations and laboratory features between severe dengue and non-severe dengue
Table 2.
Variable Total (n=3,692) Severe dengue pa)
Yes (n=56) No (n=3,636)
Clinical manifestation
 Fever 3,692 (100.0) 56 (100.0) 3,636 (100.0) NA
 Fatigue 3,341 (90.5) 43 (76.8) 3,298 (90.7) <0.001
 Body aches 2,684 (72.7) 42 (75.0) 2,642 (72.7) 0.697
 Headache 2,355 (63.8) 44 (78.6) 2,311 (63.6) 0.020
 Anorexia 574 (15.5) 6 (10.7) 568 (15.6) 0.315
 Vomiting/nausea 541 (14.7) 12 (21.4) 529 (14.5) 0.149
 Chest pain 188 (5.1) 0 (0) 188 (5.2) -
 Cough 182 (4.9) 9 (16.1) 173 (4.8) <0.001b)
 Palpitations 171 (4.6) 4 (7.1) 167 (4.6) 0.368b)
 Skin rash 112 (3.0) 7 (12.5) 105 (2.9) <0.001b)
 Pruritic rash 99 (2.7) 5 (8.9) 94 (2.6) 0.004b)
 Hemorrhage 94 (2.5) 7 (12.5) 87 (2.4) <0.001b)
 Dizziness 31 (0.8) 3 (5.4) 28 (0.8) <0.001b)
 Myalgia 22 (0.6) 2 (3.6) 20 (0.6) 0.004b)
 Retro-orbital pain 13 (0.4) 1 (1.8) 12 (0.3) 0.068b)
Clinical laboratory features
 RBC (×1012/L) 4.65±0.57 4.61±0.61 4.65±0.57 0.597
 WBC (×109/L) 4.62±2.36 4.22±1.91 4.63±2.36 0.200
 PLT (×109/L) 84.68±63.80 88.77±42.47 84.62±64.08 0.475
 Hb (g/L) 146.82±13.64 147.02±14.19 146.81±13.64 0.909
 Hct (%) 40.46±4.90 40.39±4.70 40.46±4.90 0.912
 AST (U/L) 33.95 (23.73–73.05) 48.80 (26.80–132.33) 33.90 (23.63–71.53) 0.021
 ALT (U/L) 27.80 (17.80–52.53) 35.40 (17.65–79.93) 27.75 (17.80–51.80) 0.058

Data are presented as n (%), mean±standard deviation, or median (interquartile range).

RBC, red blood cell; WBC, white blood cell; PLT, platelet; Hb, hemoglobin; Hct, hematocrit; AST, aspartate aminotransferase; ALT, alanine aminotransferase; NA, statistical test not applicable.

a)p-values were calculated using the chi-square test or Fisher exact test (when ≥25% of expected cell counts were <5) for categorical variables and the independent-samples t-test or Mann-Whitney U-test for continuous variables.

b)By Fisher exact test.

Table 3.
Association between pre-existing illnesses and severe dengue (n=3,692)
Table 3.
Variable Severe dengue (n, %) OR (95% CI) p aOR (95% CI) p
Yes (n=56) No (n=3,636)
Model 1. Any pre-existing illness
 No 24 (1.1) 2,202 (98.9) 1 1
 Yes 32 (2.2) 1,434 (97.8) 2.05 (1.20–3.49) 0.008 2.06 (1.20–3.53) 0.009
Model 2. Number of pre-existing illnesses
 0 24 (1.1) 2,202 (98.9) 1 1
 1 16 (2.0) 773 (98.0) 1.90 (1.00–3.59) 0.049 1.89 (0.99–3.60) 0.051
 ≥2 16 (2.4) 661 (97.6) 2.22 (1.17–4.21) 0.014 2.26 (1.18–4.33) 0.014
Model 3. Pre-existing illnesses
 Hypertension 16 (2.4) 659 (97.6) 1.81 (1.01–3.25) 0.048 1.36 (0.68–2.73) 0.385
 Hyperlipidemia 16 (3.2) 490 (96.8) 2.57 (1.43–4.62) 0.002 2.32 (1.17–4.81) 0.024
 Diabetes 5 (1.3) 367 (98.7) 0.87 (0.35–2.20) 0.774 0.58 (0.22–1.54) 0.277
 Lung disease 7 (2.0) 342 (98.0) 1.38 (0.62–3.06) 0.434 1.23 (0.55–2.79) 0.615
 Liver disease 5 (2.5) 199 (97.5) 1.69 (0.67–4.29) 0.267 1.92 (0.75–4.90) 0.173
 Kidney disease 1 (0.7) 143 (99.3) 0.44 (0.06–3.23) 0.423 0.44 (0.06–3.22) 0.416
 Cardiac disease 5 (4.0) 121 (96.0) 2.85 (1.12–7.26) 0.028 1.95 (0.72–5.29) 0.187
 Heart failure 0 (0) 21 (100) NA NA NA NA
 Asthma 0 (0) 5 (100) NA NA NA NA
Model 4. Hypertension, hyperlipidemia
 No HT, no HL 34 (1.2) 2,773 (98.8) 1 1
 HT, no HL 6 (1.6) 373 (98.4) 1.31 (0.55–3.15) 0.543 1.33 (0.55–3.21) 0.525
 No HT, HL 6 (2.9) 204 (97.1) 2.40 (0.99–5.78) 0.051 2.47 (1.01–6.03) 0.047
 HT and HL 10 (3.4) 286 (96.6) 2.85 (1.39–5.83) 0.004 2.88 (1.39–5.97) 0.005
Model 5. Hypertension, cardiac disease
 No HT, no CD 38 (1.3) 2,909 (98.7) 1 1
 HT, no CD 13 (2.1) 606 (97.9) 1.64 (0.87–3.10) 0.126 1.64 (0.86–3.12) 0.134
 No HT, CD 2 (2.9) 68 (97.1) 2.25 (0.53–9.52) 0.270 2.25 (0.53–9.54) 0.273
 HT and CD 3 (5.4) 53 (94.6) 4.33 (1.30–14.48) 0.017 4.39 (1.30–14.79) 0.017
Model 6. Hyperlipidemia, cardiac disease
 No HL, no CD 38 (1.2) 3,087 (98.8) 1 1
 HL, no CD 13 (2.9) 428 (97.1) 2.47 (1.30–4.67) 0.006 2.50 (1.31–4.79) 0.006
 No HL, CD 2 (3.3) 59 (96.7) 2.75 (0.65–11.68) 0.169 2.77 (0.65–11.82) 0.169
 HL and CD 3 (4.6) 62 (95.4) 3.93 (1.18–13.08) 0.026 4.02 (1.19–13.53) 0.025

All models were adjusted for sex, age group, place of residence, and overweight/obesity. Percentages are presented as row percentages to illustrate the proportion of severe dengue within each category of pre-existing conditions.

OR, odds ratio; CI, confidence interval; aOR, adjusted odds ratio; HT, hypertension; HL, hyperlipidemia; CD, cardiac disease; NA, Variable not included in the model due to zero event.

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Metabolic and cardiovascular comorbidities as predictors of severe dengue in Vietnamese adults: a retrospective study, 2022–2024
Osong Public Health Res Perspect. 2026;17(2):136-144.   Published online March 19, 2026
DOI: https://doi.org/10.24171/j.phrp.2025.0316
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Metabolic and cardiovascular comorbidities as predictors of severe dengue in Vietnamese adults: a retrospective study, 2022–2024
Osong Public Health Res Perspect. 2026;17(2):136-144.   Published online March 19, 2026
DOI: https://doi.org/10.24171/j.phrp.2025.0316
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