Comparative Analysis of Hematological, Biochemical, and Inflammatory Biomarkers in Malaria and Dengue Patients in an Endemic Setting of Pakistan

Abstract Objective To compare the hematological, biochemical, and selected derived inflammatory biomarker profiles of laboratory-confirmed malaria and dengue patients presenting to secondary-care hospitals in District Swat, Khyber Pakhtunkhwa, Pakistan, and to identify routine laboratory parameters with the greatest potential to support early clinical differentiation of the two infections in resource-constrained endemic settings. Methods A hospital-based comparative cross-sectional study was conducted at the Tehsil Headquarter (THQ) and District Headquarter (DHQ) hospitals of District Swat. Fifty-five malaria and 55 dengue laboratory-confirmed cases were enrolled through consecutive sampling after written informed consent. Hematological parameters (hemoglobin, hematocrit, total white blood cell count, platelet count, neutrophils, lymphocytes, monocytes, eosinophils), biochemical markers (blood urea, serum creatinine, total bilirubin, alanine aminotransferase (ALT), and derived inflammatory indices (neutrophil-to-lymphocyte ratio (NLR) and neutrophil-to-monocyte ratio (NMR) were measured on venous blood drawn at presentation. All analyses were performed in SPSS version 26.0, with a two-sided alpha of 0.05. Results The 110 enrolled patients comprised 55 malaria (mean age 21.76 ± 16.82 years; 58.2% male) and 55 dengue (mean age 31.71 ± 14.41 years; 61.8% male) cases. Dengue patients were significantly older (p = 0.001) and had a marginally higher mean body temperature (102.98 ± 0.76°F vs 102.64 ± 0.95°F; p = 0.037); sex distribution did not differ (p = 0.846). Hemoglobin (14.81 ± 2.20 vs 12.41 ± 1.70 g/dL; p < 0.001; d = + 1.26) and hematocrit (41.52 ± 6.04 vs 33.99 ± 4.81%; p < 0.001; d = + 1.44) were significantly higher in dengue. Biochemically, dengue patients had significantly higher blood urea (43.25 ± 11.45 vs 29.51 ± 8.12 mg/dL; p < 0.001), serum creatinine (1.05 ± 0.28 vs 0.84 ± 0.40 mg/dL; p = 0.001), and ALT (119.67 ± 55.32 vs 52.73 ± 27.25 U/L; p < 0.001). Total bilirubin (p = 0.082), total white cell count, platelet count, leukocyte differentials, NLR (p = 0.603), and NMR (p = 0.928) did not differ significantly between groups. Conclusion Malaria and dengue patients presenting to secondary care in District Swat exhibit distinct hematological and biochemical profiles. Higher hemoglobin, hematocrit, blood urea, serum creatinine, and ALT, consistent with the plasma-leakage and hepatic/renal tropism of dengue, retained the largest effect sizes and are the most promising routine laboratory candidates for an ancillary differentiation algorithm.