Pulmonary edema in Dengue: a systematic review and meta-analysis

Background: Pulmonary edema is a potentially life-threatening complication of dengue. The recorded incidence of pulmonary edema has varied widely between studies. Therefore, we aimed to systematically review the literature on this topic and, through meta-analysis, estimate the pooled incidence of pulmonary edema in dengue using published data. Methods: A systematic search of the PubMed, Scopus, and Web of Science databases was conducted from January 2000 to February 2025, in accordance with the PRISMA 2020 guidelines. Studies reporting the incidence of pulmonary edema in patients with dengue were included. Pooled incidence estimates for pulmonary edema in dengue were calculated via meta-analysis in R version 4.3.2 using a random-effects model. Results: Our search revealed 432 results, of which five studies met our inclusion criteria. The incidence of pul monary edema among dengue patients varied across studies, ranging from low to moderate. We observed minimal risk of bias across studies. Our meta-analysis found a pooled incidence of pulmonary edema in dengue of 9.14% [95% CI = 6.98%-11.89%]. Conclusion: Our investigation suggests that a non-negligible proportion of dengue patients may develop pulmonary edema. Acknowledging the risk of pulmonary edema and monitoring it are essential to ensuring effective prevention of pulmonary morbidity in dengue. Additionally, we suggest that clinicians assess for underlying dengue infection when managing pulmonary edema, particularly in regions at high risk.