To Study the Serum Calcium Level in Dengue Fever ” - A One Year Cross Sectional Study in a Tertiary Care Hospital

Abstract

BACKGROUND& OBJECTIVES: Dengue is currently regarded globally as the most important mosquito-borne viral disease, contributing to significant morbidity and mortality across the globe. Association between low serum calcium levels and its positive impact on treatment outcomes has been studied by multiple researchers. But due to limited number of available, the quality of evidence available on the subject is still poor. Hence there is a strong need for further studies on the subject, specially on Indian population. The current study was conducted in this background, with an objective to study the association between the severity of dengue infection and serum calcium levels. MATERIALS AND METHODS: The current study was a cross sectional study,conducted in the department of general medicine, DR. Prabhakar Kore hospital, KLE University, Belgaum. A total 100 dengue cases receiving treatment from the study setting between January 2017 to December 2017, selected by universal sampling were included in the final analysis. The study included all the proved cases of dengue fever admitted in the study setting. The study has excluded patients with hypertension, diabetes mellitus, cardiac disease and those on antihypertensive and antiarrhythmic medication.Patients those who are on calcium supplement or any other drugs which affect calcium homeostasis were also excluded. All the relevant parameters were documented in a structured study proforma. Confirmation of diagnosis was done with one of the following laboratory tests: IgM antibody, IgG antibody or serum dengue NS1 Antigen detection..The prevalence of myocarditis is diagnosed either by the presence of changes in the 12 lead ECG (ST Segment, T Inversion or right bundle branch block).Hypocalcaemia was defined as the presence of serum calcium < 8.5 mg/dl. RESULTS A total of 100 subjects were included in the final analysis. The mean age of the study population was 26.64 ± 10.65 with the ranged between 18 to 70 years.Among the study population, 10 (10%) participants were aged between 18 to 19 years, 53 (53%) were aged between 20 to 29 years, 18 (18%) were aged between 30 to 39 years, 13 (13%) were aged between 40 to 49 years, 3 (3%) were aged between 50 to 59 years and 3 (3%) were aged 60 and above years.Among the study population, 74 (74%) participants were males, and the remaining 26 (26%) were females.The mean Hemoglobin of study population was 14.32 ± 2.33 with the ranged between 9 to 20 g/dl.The mean Total count of the study population was 264.38 ± 1924.42 with the ranged from 0.40 to 17300 cells / µL. The mean platelet of the study population was 62686.87 ± 8647.45 with the ranged between 5000 to 253000 cells/µL.Among the Ns1 antigen was positive in 28% and negative in 72%, 68% were IgM Antibody positive, 71% of patients were IgG antibody positive and 50 (50%) participants had both Dengue IgM + IgG antibody Positive. Among the study population, 72 (72%) participants had Dengue fever. The number of Dengue Hemorrhagic fever and Dengue shock syndrome were 23(23%) and 5(5%) respectively. The median serum calcium of the study population was 8.40 (8.20 to 8.60) mg/dl. Among the participants with NS1 antigen positive and Dengue IgG antibody positive had no statistically significant association with median calcium values. Among the people with Dengue IgM antibody positive, the median serum calcium was 8.0 (IQR 7 to 8.60) mg/dl, and it was 8.60 (IQR 8.45 to 9) mg/dl in people with Dengue IgM antibody negative (P Value 0.04).Among the people with Dengue IgM + IgG antibody positive, the median serum calcium was 8.20 mg/dl (IQR 8.20 to 8.60), and it was 8.50 mg/dl (IQR 8.40 to 8.68) in people with Dengue IgM + IgG antibody negative (P Value 0.022). None of the subjects in dengue fever and DHF groups had serum calcium level below 7 mg/dl, but 20% of the subjects in DSS had serum calcium less than 7 mg/dl. A higher proportion of subjects in dengue shock syndrome and DHF had lower levels of serum calcium, as compared to dengue fever. The proportion of participants with cardiac and neurological complications increased with increasing severity ranging from dengue fever to dengue hemorrhagic fever and dengue shock syndrome CONCLUSIONS: The current study has documented a strong association between the dengue severity, IgM antibody positive status and lower serum calcium levels. There is a need to conduct large scale prospective studies to further assess the independent risk factors for hypocalcemia among dengue cases and its impact on treatment outcomes and mortality.