Determinants of Prolonged Hospitalization among Dengue Patients in Nepal: A Multicenter Retrospective Study

Abstract

Though dengue causes a high burden of hospitalizations in tropical regions, little is known about predictors of length stay (LOS) among dengue patients in Nepal. This study aims to determine demographic, clinical and laboratory predictors of prolonged hospitalisation for dengue patients in tertiary hospitals of Nepal. This was a hospital based designed as retrospective cross-sectional study consisting of data from January 1 to December 31, 2024 (twelve months) from three hospitals in Kathmandu, Bharatpur and Pokhara with sample size of 529 total dengue inpatients. Data were extracted from patients’ files, such as socio-demographics, co-morbidities, admission laboratory data and length of stay. Statistical analyses using nonparametric tests, chi-square statistics, Fisher’s exact tests, and logistic regression identified significant predictors.

Of the total 529 patients, 90 have been identified as having prolonged hospitalization (17.0%). The majority of the patients who suffered prolonged hospitalization lived in urban areas (AOR 1.74, 95% CI 1.00-3.04; p=0.05), had several underlying conditions (AOR 2.04, 95% CI 1.18-3.53; p=0.01), and presented with high levels of direct bilirubin (AOR 4.93, 95% CI 1.34-18.12; p=0.02). A borderline correlation was identified with lower packed cell volume (AOR 0.95, 95% CI 0.90-1.00; p=0.05), while platelet count was considered to have borderline significance. Sex, age, and levels of prolonged hospitalization experienced were found to have no correlation with the disease. The model showed an 84.5% accuracy.

In the context of Nepal, the prolonged hospitalization of patients with dengue fever was found to be associated with the patient’s urban residency, underlying conditions and abnormalities of the blood and liver. These findings insist on the importance of early risk stratification to improve the targeted allocation of limited hospital resources, during an outbreak of dengue fever.