title: Diabetes mellitus increases severity of thrombocytopenia in dengue-infected patients.
abstract: BACKGROUND
  Diabetes mellitus is known to exacerbate bacterial infection, but its effect on the severity of viral infection has not been well studied. The severity of thrombocytopenia is an indicator of the severity of dengue virus infection. We investigated whether diabetes is associated with thrombocytopenia in dengue-infected patients.
  
  
  METHODS
  We studied clinical characteristics of 644 patients with dengue infection at a university hospital during the epidemic on 1 June 2002 to 31 December 2002 in Taiwan. Platelet counts and biochemical data were compared between patients with and without diabetes. Potential risk factors associated with thrombocytopenia were explored using regression analyses.
  
  
  RESULTS
  Dengue-infected patients with diabetes had lower platelet counts than patients without diabetes during the first three days (54.54±51.69 vs. 86.58±63.4 (p≤0.001), 43.98±44.09 vs. 64.52±45.06 (p=0.002), 43.86±35.75 vs. 62.72±51.2 (p=0.012)). Diabetes mellitus, death, dengue shock syndrome (DSS) and dengue hemorrhagic fever (DHF) and increased glutamic-pyruvate transaminase (GPT) levels were significantly associated with lower platelet counts during the first day of hospitalization for dengue fever with regression β of -13.981 (95% confidence interval (CI) -27.587, -0.374), -26.847 (95% CI -37.562, -16.132), and 0.054 (95% CI 0.015, 0.094) respectively. Older age, hypoalbuminemia, and hypertriglyceridemia were independently correlated with thrombocytopenia in dengue patients with or without diabetes with regression β of -2.947 (p=0.004), 2.801 (p=0.005), and -3.568 (p≤0.001), respectively. Diabetic patients with dengue had a higher rate of dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS) than non-diabetic patients. They also had lower blood albumin, were older, and higher triglyceride levels. Older age, hypoalbuminemia, and hypertriglyceridemia were independently correlated with thrombocytopenia in dengue patients.
  
  
  CONCLUSIONS
  Dengue patients with diabetes tended to have more severe thrombocytopenia and were more likely to have DHF/DSS. Older age, hypoalbuminemia, and hypertriglyceridemia were independently associated with more severe thrombocytopenia in dengue patients.
authors: Chin Pin Clinic, Kaohsiung 807, Taiwan. wecaredm223@yahoo.com.tw.
authors: Chung-Yuan
authors: CY
authors: Chen
authors: Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung 812, Taiwan. lovellelee@hotmail.com.
authors: Mei-Yueh
authors: MY
authors: Lee
authors: Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan. 890073@kmuh.org.tw.
authors: Kun-Der
authors: KD
authors: Lin
authors: Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung 812, Taiwan. my345677@yahoo.com.tw.
authors: Wei-Hao
authors: WH
authors: Hsu
authors: Lee's Clinic, Ping Tung 900, Taiwan. leesclinic@leesclinic.org.
authors: Yaun-Jinn
authors: YJ
authors: Lee
authors: Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan. pjhsiao@cc.kmu.edu.tw.
authors: Pi-Jung
authors: PJ
authors: Hsiao
authors: Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan. sjshin@kmu.edu.tw.|Center for Lipid and Glycomedicine Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan. sjshin@kmu.edu.tw.
authors: Shyi-Jang
authors: SJ
authors: Shin
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D003715:Dengue / Q000097:blood* / Q000150:complications; D048909:Diabetes Complications / Q000097:blood / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013921:Thrombocytopenia / Q000150:complications / Q000209:etiology*
chemical_list: D000410:Alanine Transaminase