Prevalence and clinical impact of heart failure in dengue-infected patients with Clarkson's disease

Background: Dengue fever is a mosquito-borne viral infection with significant public health implications, especially in tropical regions. Capillary leakage syndrome (CLS), a severe complication of dengue, may lead to circulatory failure and multi-organ dysfunction. Emerging evidence links dengue to cardiac complications, yet the prevalence of heart failure in dengue patients with CLS remains underexplored. This study assessed the prevalence and clinical impact of heart failure in dengue patients with CLS. Methods: A cross-sectional observational study was conducted at Government Medical College, Srikakulam, from September 2023 to February 2025. A total of 350 adult dengue patients were included. Patients were categorized based on the presence of heart failure and CLS. Laboratory parameters (hematocrit, serum albumin, NT-proBNP, troponin I) and cardiac assessments (ECG, echocardiography, chest X-ray) were analyzed. Statistical analysis identified predictors of heart failure in dengue patients with CLS. Results: Heart failure was diagnosed in 44 patients (12.5%) with concurrent CLS. Patients had elevated hematocrit (48.5%±5.2), low serum albumin (1.8±0.4 g/dl) and raised NT-proBNP (1500±324 pg/ml) and troponin I (0.56±0.22 ng/ml). Echocardiography revealed reduced ejection fraction (28%), myocarditis (22%), pulmonary congestion (18%) and arrhythmias (16%). Significant predictors of heart failure included NT-proBNP>500 pg/ml, hypoalbuminemia <3.0 g/dl, hyponatremia <135 mmol/l and myocarditis on echocardiography. Conclusions: Heart failure is an underrecognized but significant complication in dengue patients with CLS. Biomarker screening and early cardiac evaluation are vital for timely intervention and improved outcomes.