Liver dysfunction and its outcome in patients with dengue infection

Abstract

OBJECTIVES: To determine the frequency and severity of liver dysfunction due to dengue infection among hospitalised patients. METHOD: A retrospective, descriptive study was done at University Medical Unit, Colombo North Teaching Hospital. Records of all serologically confirmed dengue (IgM antibody positive) patients admitted from 1/1/09-31/1/10 were analysed. Results of blood tests, imaging and serology were noted. A diagnosis of acute liver failure was made in patients with an INR >1.5 together with hepatic encephalopathy. Patients on hepatotoxic drugs, alcohol abusers and patients with known chronic liver diseases (total 14 patients) were excluded from the analysis. RESULTS: Of 328 patients (58.5% female), aged 14-68 years (mean 38) with confirmed dengue, 169 (51.5%) had dengue fever, 147 (34.2%) dengue haemorrhagic fever (grade 1 and 2) and 47 (14.3%) dengue shock syndrome. 257 (78.4%) had elevated hepatic transaminases of whom 153 (46.6%) had minimal elevation (<3 times upper limit) and 38 (11.6%) had >1000 IU/1. Of those with elevated transaminases, 94% had AST: ALT >1. Thirteen (3.9%) with transaminases >1000 IU /I developed acute liver failure of whom 2 died. In 3 patients of whom 1 died, ischaemic liver injury (prolonged shock followed by rapid rise in ALT>AST) probably accounted for abnormal transaminases. Presence of nausea or vomiting at the time of AST/ALT>1000 was the only independent risk factor for development of acute liver failure (pO.OOl) on multivariate analysis. CONCLUSION: Abnormal liver function was common among hospitalised dengue patients. Liver failure was uncommon, and nausea or vomiting at the time of AST/ALT>1000 predicted its development.