Development of a PIMS Specific Dengue Hepatitis Severity Score: A Retrospective Cross Sectional Study of EMR Data

PIMS Specific Dengue Hepatitis Severity Score

Abstract

Background:
Hepatic involvement is a frequent complication of dengue infection, which is a significant problem of public health in endemic areas. Dengue hepatitis is linked to the high morbidity and risk of severe clinical outcome, but there are no easy bedside instruments to detect high-risk patients at the beginning of hospitalization.

Objective:
To develop and internally validate a PIMS-specific Dengue Hepatitis Severity Score for predicting severe dengue hepatitis using routinely available clinical variables.

Methods:
The study was a retrospective cross-sectional study that was carried out at the Department of General Medicine, Pakistan Institute of Medical Sciences (PIMS), Islamabad, based on electronic medical records data of dengue-infected patients with hepatic involvement admitted between  ≥13 years of age between June 2025 and November 2025. Clinical, laboratory and outcome data were retrieved. Independent predictors of severe dengue hepatitis were determined by multivariate logistic regression, and a severity score was created. The analysis of receiver operating characteristic (ROC) curves was done to determine diagnostic performance.

Results:
A total of 97 patients were included. Bleeding (OR = 11.24), hypotension (OR = 6.99), and hepatomegaly (OR = 5.95) were identified as independent predictors of severe dengue hepatitis (p < 0.05 for all). A three-point severity score was developed using these variables. The score demonstrated good discriminatory performance with an AUC of 0.761 (95% CI: 0.659–0.863). A cut-off value of ≥1 yielded a sensitivity of 77.1% and specificity of 71.0%.

Conclusion:
The PIMS Dengue Hepatitis Severity Score is a simple and effective bedside tool for early identification of severe dengue hepatitis. Its application may improve risk stratification and guide timely clinical management. External validation is recommended before routine use.