Incidence of acute pancreatitis among hospitalized patients with dengue: A systematic review and meta-analysis

Background: Acute pancreatitis (AP) is an under-recognized but clinically relevant complication of dengue fever (DF), associated with rapid clinical deterioration and increased risk of mortality. However, the true incidence of this condition remains uncertain. Methods: Following PRISMA 2020 guidelines, we systematically searched PubMed, Web of Science, Embase and China National Knowledge Infrastructure (CNKI) up to May 2025 for observational studies reporting AP among DF hospitalized patients. Eligible studies were identified according to predefined inclusion and exclusion criteria based on the Population, Intervention, Comparison, Outcome, and Study design (PICOS) framework. Two reviewers independently screened the literature and assessed study quality using the Newcastle–Ottawa Scale (NOS). Pooled incidence rates were estimated using random or common effect models depending on heterogeneity. Results: Eight observational studies from five countries, comprising 1,078 hospitalized patients with DF, were included. Among them, 135 were diagnosed with AP. The pooled incidence of AP complicating DF was 12.4% (95% CI: 10.5–14.4%). Subgroup analysis suggested a higher incidence in studies with ≥100 participants compared to smaller cohorts (13.5% vs. 8.3%, P = 0.03). No evidence of significant publication bias was detected. Conclusion: DF-associated AP represents a clinically important complication, given the global burden of dengue and the potential severity of AP. Our findings underscore the importance of considering pancreatic enzyme testing, supplemented by imaging when clinically warranted, in dengue patients with persistent or severe abdominal symptoms and/or features of severe dengue. Large-scale, multicenter prospective studies are warranted to establish the true incidence and case-fatality risk, thereby informing evidence-based prevention and management strategies. Author summary: Dengue fever (DF) is one of the fastest growing mosquito-borne diseases worldwide, affecting millions of people each year. Although most patients present with mild symptoms such as fever, rash, and body aches, dengue can also cause severe and sometimes unexpected complications. One such complication is acute pancreatitis (AP), a sudden inflammation of the pancreas that may lead to serious illness and even death. To better understand this link, we performed a systematic review and meta-analysis by combining data from eight studies across five countries. Among more than 1,000 hospitalized patients with laboratory-confirmed DF, approximately one in eight developed AP. This finding indicates that AP is a clinically important complication of DF that should not be overlooked.Our study highlights the need for heightened clinical vigilance for abdominal symptoms in dengue patients, with targeted pancreatic enzyme testing and imaging when clinically indicated in those with persistent or severe abdominal symptoms and/or features of severe DF patients. Early recognition and management of this complication may reduce the risk of poor outcomes. Larger, multicenter studies are still required to confirm the true burden and improve treatment strategies.