Dengue warning signs persisting post-48h demand monitoring to avert severe complications

Dengue virus infection remains a major public health challenge in tropical regions, with heterogeneous progression to severe disease.

We conducted a prospective longitudinal study of 362 laboratory-confirmed dengue patients, stratified by sex and the presence of warning signs. Serial hematological, hepatic and renal markers were collected over 96h (at 24h, 48h, 72h, and 96h after symptom onset) to analyze their dynamic evolution.

Patients with warning signs persisting beyond 48h exhibited progressive hematological and hepatic deterioration, unlike those without warning signs. This was characterized by progressively declining platelet and neutrophil counts, elevated hematocrit, and rising AST/ALT levels. These worsening trends were more pronounced in women, who also showed a higher prevalence of warning signs (32% vs 25% in men).

The persistence of warning signs beyond 48h represents a clinically relevant threshold for hematological and hepatic deterioration, supporting the need for protocolized monitoring - including serial platelet counts, hematocrit, and liver enzymes - during this critical window to enable early intervention in high-risk patients.