Vol. 26 No. 2 (2026): April - Juni
Open Access
Peer Reviewed

The Association Between Comorbidities and Severity of Dengue Among Adults in Lombok

Authors

Khairifathiyyah Khairifathiyyah , Indah Sapta Wardani , Philip Habib , Dewi Suryani

DOI:

10.29303/jbt.v26i2.11995

Published:

2026-06-03

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Abstract

Dengue remains a major public health concern in Indonesia, particularly in Lombok, West Nusa Tenggara, where evidence on the association between comorbidities and dengue severity is limited. This study aimed to assess the relationship between comorbidities and dengue severity among adults in Lombok. A retrospective cross-sectional study was conducted using medical records of adult dengue patients treated at West Nusa Tenggara Province General Hospital between 2023 and 2024. Fisher’s exact test was used for statistical analysis. A total of 154 patients were included, comprising 66 patients with comorbidities and 88 without comorbidities. Gastrointestinal and hepatobiliary diseases were the predominant organ-system comorbidity category, while pneumonia and type 2 diabetes mellitus were the most common individual comorbidities. No significant association was found between comorbidities and dengue severity (p > 0.05). However, the findings should be interpreted cautiously due to unequal distribution of severity categories and limited number of dengue shock syndrome cases. In conclusion, no significant association was observed between comorbidities and dengue severity among adult patients in Lombok. Future multicenter studies with larger and more balanced samples are needed to investigate determinants of dengue severity. Additional clinical, immunological, and virological factors should be evaluated to improve risk stratification and patient management.

Keywords:

Adult Dengue Comorbidity Disease Severity Lombok

References

Ahmad, M. H., Ibrahim, M. I., Mohamed, Z., Ismail, N., Abdullah, M. A., Shueb, R. H., & Shafei, M. N. (2018). The sensitivity, specificity and accuracy of warning signs in predicting severe dengue, the severe dengue prevalence and its associated factors. International Journal of Environmental Research and Public Health, 15(9), 2018. https://doi.org/10.3390/ijerph15092018

Chang, C. J., Chen, C. S., Tien, C. J., & Lu, M. R. (2018). Epidemiological, clinical and climatic characteristics of dengue fever in Kaohsiung City, Taiwan with implication for prevention and control. PLoS ONE, 13(1), e0190637. https://doi.org/10.1371/journal.pone.0190637

Ha, T. A., León, T. M., Lalangui, K., Ponce, P., Marshall, J. M., & Cevallos, V. (2021). Household-level risk factors for Aedes aegypti pupal density in Guayaquil, Ecuador. Parasites & Vectors, 14(1), 458. https://doi.org/10.1186/s13071-021-04913-0

Health Office of West Nusa Tenggara Province. (2023). Strategic plan of the Health Office of West Nusa Tenggara Province 2024–2026. https://dinkes.ntbprov.go.id/rencana-strategis/

Health Office of West Nusa Tenggara Province. (2024). Number of dengue hemorrhagic fever (DHF) cases in West Nusa Tenggara Province. https://data.ntbprov.go.id/dataset/jumlah-kasus-demam-berdarah-dangue-dbd-di-provinsi-ntb

Huang, N., Shen, Y., Chou, Y., et al. (2023). Advanced age and increased risk for severe outcomes of dengue infection, Taiwan, 2014–2015, 29(8), 1701–1702. https://doi.org/10.3201/eid2908.230014

Huang, W. C., Lee, I. K., Chen, Y. C., Tsai, C. Y., & Liu, J. W. (2018). Characteristics and predictors for gastrointestinal hemorrhage among adult patients with dengue virus infection: emphasizing the impact of existing comorbid disease(s). PLoS ONE, 13(2), e0192919. https://doi.org/10.1371/journal.pone.0192919

Ipa, M., Hermawan, A., Yunarko, R., Ramadhani, T., Hidajat, M. C., Hendarwan, H., ... & Wibawa, T. (2026). Urban-rural disparities in self-reported dengue infection: A comprehensive analysis of the 2023 Indonesian health survey. Global Transitions, 8(1), 10-21. https://doi.org/10.1016/j.glt.2025.08.003

Islam, S., Haque, C. E., Hossain, S., & Hanesiak, J. (2021). Climate variability, dengue vector abundance and dengue fever cases in Dhaka, Bangladesh: a time-series study. Atmosphere, 12(7), 905. https://doi.org/10.3390/atmos12070905

Latt, K. Z., Poovorawan, K., Sriboonvorakul, N., Pan-ngum, W., Townamchai, N., & Muangnoicharoen, S. (2020). Diabetes mellitus as a prognostic factor for dengue severity : retrospective study from Hospital for Tropical Diseases, Bangkok. Clinical Practice, 7-8, 100028. https://doi.org/10.1016/j.clinpr.2020.100028

Lee, I. K., Hsieh, C. J., Lee, C. T., & Liu, J. W. (2020). Diabetic patients suffering dengue are at risk for development of dengue shock syndrome/severe dengue: emphasizing the impacts of co-existing comorbidity(ies) and glycemic control on dengue severity. Journal of Microbiology, Immunology and Infection, 53(1), 69–78. https://doi.org/10.1016/j.jmii.2017.12.005

Lien, C. E., Chou, Y. J., Shen, Y. J., Tsai, T., & Huang, N. (2021). A population-based cohort study on chronic comorbidity risk factors for adverse dengue outcomes. The American Journal of Tropical Medicine and Hygiene, 105(6), 1544–1551. https://doi.org/10.4269/ajtmh.21-0716

Mahato, A. K., Shrestha, N., Gharti, S. B., & Shah, M. (2022). Typhoid fever among patients diagnosed with dengue in a tertiary care center : a descriptive cross-sectional study. JNMA Journal of Nepal Medical Association, 60(252), 714–717. https://doi.org/10.31729/jnma.7624

Marois, I., Forfait, C., Inizan, C., Klement-Frutos, E., Valiame, A., Aubert, D., Gourinat, A. C., Laumond, S., Barsac, E., Grangeon, J. P., Cazorla, C., Merlet, A., Tarantola, A., Dupont-Rouzeyrol, M., & Descloux, E. (2021). Development of a bedside score to predict dengue severity. BMC Infectious Diseases, 21(1), 470. https://doi.org/10.1186/s12879-021-06146-z

Ministry of Health of the Republic of Indonesia. (2024). Beware of diseases during the rainy season. https://kemkes.go.id/id/waspada-penyakit-di-musim-hujan

Ng, W. Y., Atan, R., Mohd Yunos, N., Bin Md Kamal, A. H., Roslan, M. H., Quah, K. Y., Teh, K. X., Zaid, M., Kassim, M., Mariapun, J., Ngim, C. F., Dhanoa, A., & Yeo, T. W. (2022). A double whammy: the association between comorbidities and severe dengue among adult patients—a matched case-control study. PLoS ONE, 17(9), e0273071. https://doi.org/10.1371/journal.pone.0273071

Nabila, S. L., Sulistiawati, Bramantono, & Ummi, M. (2024). Comorbid factors and duration of illness in dengue hemorrhagic fever patients at Universitas Airlangga Hospital, Surabaya, Indonesia, 5(1), 71–78. https://doi.org/10.20473/jcmphr.v5i1.52966

Pham, O. K., Duong, T. B., Phan, T. V., Truong, T. N., Ha, D. T. H., Nguyen, H. V., Hien, V. T. M., Dong, T. H. K., Vuong, N. L., Yen, L. M., Yacoub, S., Thwaites, C. L., & Tam, D. T. H. (2025). Severe dengue in adults: clinical features from the 2022 dengue outbreak at a Vietnamese tertiary hospital. PLoS Neglected Tropical Diseases, 19(10), e0013589. https://doi.org/10.1371/journal.pntd.0013589

Pulock, O. S., Mannan, A., Chowdhury, A. F. M. N., Tousif, G., Majumder, K., Monsur, S., Mehedi, H. M. H., Kaiser, E., Sultana, A., Sagar, M. A. H., Etu, S. N., Alam, N., Mazid, A. H. M. T., & Sattar, M. A. (2025). Clinical spectrum and risk factors of severe dengue infection: findings from the 2023 dengue outbreak in Bangladesh. BMC Infectious Diseases, 25(1), 469. https://doi.org/10.1186/s12879-025-10792-y

Renard, A., Pérez Lombardini, F., Pacheco Zapata, M., Porphyre, T., Bento, A., Suzán, G., Roiz, D., Roche, B., & Arnal, A. (2023). Interaction of human behavioral factors shapes the transmission of arboviruses by Aedes and Culex mosquitoes. Pathogens, 12(12), 1421. https://doi.org/10.3390/pathogens12121421

Ruggieri, A., Anticoli, S., D’Ambrosio, A., Giordani, L., & Viora, M. (2016). The influence of sex and gender on immunity, infection and vaccination. Annali dell’Istituto Superiore di Sanità, 52(2), 198–204. https://doi.org/10.4415/ANN_16_02_11

Sangkaew, S., Ming, D., Boonyasiri, A., Honeyford, K., Kalayanarooj, S., Yacoub, S., Dorigatti, I., & Holmes, A. (2021). Risk predictors of progression to severe disease during the febrile phase of dengue: a systematic review and meta-analysis. The Lancet Infectious Diseases, 21(7), 1014–1026. https://doi.org/10.1016/S1473-3099(20)30601-0

Shahid Ansari, M., Jain, D., Harikumar, H., Rana, S., Gupta, S., Budhiraja, S., & Venkatesh, S. (2021). Identification of predictors and model for predicting prolonged length of stay in dengue patients. Health Care Management Science, 24(4), 786–798. https://doi.org/10.1007/s10729-021-09571-3

Teixeira, M. G., Paixão, E. S., Costa, M. da C., Cunha, R. V., Pamplona, L., Dias, J. P., Figueiredo, C. A., Figueiredo, M. A., Blanton, R., Morato, V., Barreto, M. L., & Rodrigues, L. C. (2015). Arterial hypertension and skin allergy are risk factors for progression from dengue to dengue hemorrhagic fever: a case-control study. PLoS Neglected Tropical Diseases, 9(5), e0003812. https://doi.org/10.1371/journal.pntd.0003812

Toledo, J., George, L., Martinez, E., Lazaro, A., Han, W. W., Coelho, G. E., et al. (2016). Relevance of non-communicable comorbidities for the development of the severe forms of dengue: A systematic literature review. PLoS Neglected Tropical Diseases, 10(1), e0004284. https://doi.org/10.1371/journal.pntd.0004284

Tsheten, T., Clements, A. C. A., Gray, D. J., Adhikary, R. K., Furuya-Kanamori, L., & Wangdi, K. (2021). Clinical predictors of severe dengue: a systematic review and meta-analysis. Infectious Diseases of Poverty, 10(1), 123. https://doi.org/10.1186/s40249-021-00908-2

Wang, W. H., Urbina, A. N., Chang, M. R., Assavalapsakul, W., Lu, P. L., Chen, Y. H., & Wang, S. F. (2020). Dengue hemorrhagic fever: a systematic literature review of current perspectives on pathogenesis, prevention and control. Journal of Microbiology, Immunology and Infection, 53(6), 963–978. https://doi.org/10.1016/j.jmii.2020.03.007

Wibawa, B. S. S., Wang, Y. C., Andhikaputra, G., Lin, Y. K., Hsieh, L. H. C., & Tsai, K. H. (2024). The impact of climate variability on dengue fever risk in Central Java, Indonesia. Climate Services, 33, 100433. https://doi.org/10.1016/j.cliser.2023.100433

Wiratmadja, I. I., Salamah, S. Y., & Govindaraju, R. (2018). Healthcare data mining: predicting hospital length of stay of dengue patients. Journal of Engineering and Technological Sciences, 50(1), 110–126. https://doi.org/10.5614/j.eng.technol.sci.2018.50.1.8

World Health Organization. (2009). Dengue guidelines for diagnosis, treatment, prevention and control. WHO. https://www.who.int/publications/i/item/9789241547871

World Health Organization. (2011). Comprehensive guidelines for prevention and control of dengue and dengue haemorrhagic fever. WHO Regional Office for South-East Asia. https://iris.who.int/items/f3f4cbe8-1718-40d2-a750-c4d9480e707b

World Health Organization. (2023). Dengue – Global Stuation. https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON498

World Health Organization. (2025). Dengue and severe dengue. https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue

Yang, X., Quam, M. B. M., Zhang, T., & Sang, S. (2021). Global burden for dengue and the evolving pattern in the past 30 years. Journal of Travel Medicine, 28(8), taab146. https://doi.org/10.1093/jtm/taab146

Author Biographies

Khairifathiyyah Khairifathiyyah, Universitas Mataram

Author Origin : Indonesia

Indah Sapta Wardani, University of Mataram

Author Origin : Indonesia

Department of Internal Medicine, Faculty of Medicine and Health Science, University of Mataram,
Mataram, Indonesia

Philip Habib, University of Mataram

Author Origin : Indonesia

Department of Internal Medicine, Faculty of Medicine and Health Science, University of Mataram,
Mataram, Indonesia

Dewi Suryani, University of Mataram

Author Origin : Indonesia

Departement of Microbiology, Faculty of Medicine and Health Science, University of Mataram,
Mataram, Indonesia

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How to Cite

Khairifathiyyah, K., Wardani, I. S., Habib, P., & Suryani, D. (2026). The Association Between Comorbidities and Severity of Dengue Among Adults in Lombok . Jurnal Biologi Tropis, 26(2), 1104–1115. https://doi.org/10.29303/jbt.v26i2.11995

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