Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Wednesday, 10 / 23 / 2019

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Spectrum, Manifestations and Outcomes of Dengue Infection in Individuals with and without Liver Disease

ORIGINAL ARTICLE OPEN ACCESS

Spectrum, Manifestations and Outcomes of Dengue Infection in Individuals with and without Liver Disease

Anand V. Kulkarni1, Ashok K. Choudhury1, Madhumita Premkumar1, Priyanka Jain3, Ekta Gupta2 and Shiv Kumar Sarin*,1

1Department of Hepatology and Transplant, Institute of Liver and Biliary Sciences, New Delhi, India
2Department of Virology, Institute of Liver and Biliary Sciences, New Delhi, India
3Department of Statistics, Institute of Liver and Biliary Sciences, New Delhi, India
*Correspondence to: Shiv Kumar Sarin, Department of Hepatology, Institute of Liver & Biliary Sciences (ILBS), D-1, Vasant Kunj, New Delhi 110070, India. Tel: +91-11-46300000, Fax: +91-11-46300010, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. ; This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2019;7(2):106-111 DOI: 10.14218/JCTH.2018.00047
Received: August 14, 2018 Accepted: February 12, 2019 Published online: May 9, 2019

Abstract

Background and Aims: Dengue infection is a major health burden, which can result in mild self-limited febrile illness to highly fatal hemorrhagic disease. There is paucity of literature describing the manifestations of dengue in patients with underlying liver disease. We studied and compared the manifestations of this tropical infection in patients with and without liver disease.

Methods: Patients with serologically-confirmed dengue infection were included in this retrospective study, obtained for over a period of 1 year. Demographic and laboratory variables were compared for the individuals with no underlying liver disease (Group A, n = 71), chronic hepatitis (Group B, n = 12), and cirrhosis (Group C, n = 12).

Results: Males predominated the study population (61%), with a higher mean age in the cirrhotic group. The most common clinical manifestation was classical dengue fever, seen in 89 individuals. Two presented as dengue hemorrhagic fever (1 each in Group A and Group B), 1 presented as acute liver failure, and 3 as acute-on-chronic liver failure. Hemoconcentration was less evident in Group C as compared to Group A and Group B (p < 0.001). Patients in Group C had significantly prolonged International Normalized Ratio (INR) and enhanced thrombocytopenia compared to patients in Group A and Group B. Patients in Group C also required prolonged hospital stay (Group A: 4.83 ± 2.88, Group B: 7.33 ± 2.3, Group C: 13 ± 5 days; p < 0.001). Three patients expired in Group C compared to the 1 in Group A and none in Group B (p = 0.01). On univariate analysis, hemoglobin, albumin, INR, and bilirubin predicted development of liver failure. On multivariate analysis, INR and bilirubin predicted development of liver failure.

Conclusions: Dengue infection can have varied manifestations, ranging from simple fever to acute-on-chronic liver failure and acute liver failure. Cirrhotic patients lack classical features of dengue and have relatively poor prognosis. Dengue should be suspected as a cause of liver failure in endemic areas, where no etiological cause is discernible.

Keywords

Dengue, Cirrhosis, Acute-on-chronic liver failure, Acute liver failure

 

 

 

 

Journal of Clinical and Translational Hepatology 2019 vol. 7, 106-111  [ Html ] [ PDF Full-text ]

 

© The Authors 2018. This article is published under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

 

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