Correlation Of Coagulation Profile With Severity Of Dengue Fever With Emphasis On D-Dimer Levels: An Analytical Cross-Sectional Study

Abstract

Background: Dengue is a major arboviral infection associated with significant morbidity and mortality, with severe disease characterised by plasma leakage, coagulopathy, and bleeding. Early identification of severe cases is crucial, particularly in resource-limited settings. This study aimed to evaluate the utility of D-dimer as a pragmatic biomarker to rule out severe dengue.

Methods: 96 patients with serologically confirmed dengue were enrolled, of whole 87 had non-severe dengue and 9 had severe dengue. Clinical characteristics and laboratory parameters including platelet counts, packed cell volume (PCV), D-dimer, and other coagulation parameters. Group comparisons were performed using Mann-Whitney U-test, correlations and predictive ability.

Results: Severe dengue patients had significantly higher D-dimer levels [2800.0 (2300.4–3846.3) vs 1841.8 (917.5–2757.4) mg/L, p=0.038], higher INR [1.05 vs 0.97, p=0.035], and lower platelet counts [28,000 vs 60,000/µL, p=0.004]. D-dimer correlated negatively with platelet count (ρ –0.365, p<0.001) and positively with PCV (ρ-0.245, p0.016) and aPTT (ρ0.211, p0.039). ROC analysis identified an optimal cut-off at 2300 ng/mL (sensitivity 88.9%, specificity 62.1%, AUC 0.711). Both 2000 and 2300 ng/mL thresholds demonstrated high negative predictive values (~98%), supporting their utility as pragmatic rule-out markers.

Conclusion: D-dimer levels are significantly elevated in severe dengue and correlated with key haematological parameters. A threshold around 2000-2300mg/L offers excellent Negative predictive value, making D-dimer a feasible tool to exclude severe dengue and support triage in resource limited healthcare settings. Validation in larger multicentric cohorts is warranted.