Spectrum of Liver Dysfunction in Patients with Dengue Infection and the Markers of Severe Disease: Study from a Tertiary Care Centre in Punjab

Abstract

Introduction: Dengue is a major international health concern that is prevalent in tropical and sub tropical countries. Study of dengue infection and its Liver complications are scarce from countries like India. This study was done to assess the frequency and spectrum of liver dysfunction in Dengue infection patients. Patients and Methods:A hospital based record analysis study was performed at a tertiary care centre. All the inpatients (>18 years) who were diagnosed with dengue infection between January 2015 to May 2017 were included in this study. A total of 281 patients were included in the study. Results:Patients were classified as classical dengue fever (DF) 88.3% dengue haemorrhagic fever (DHF) 7.5% and dengue shock syndrome (DSS) 4.3%. The mean age was 43.13 (+15.50) years and male: female ratio was 2:1. Deranged serum glutamic-oxaloacetic transaminase (SGOT) and/or Serum glutamic pyruvic transaminase (SGPT) was present in 98.9 % of patients .The mean Total Bilirubin, SGOT, SGPT, albumin, ALP (alkaline phosphatase) and INR (International Normalized Ratio) values were 0.95 mg/dl, 687.28 U/L, 293.65U/L, 3.71 g/dl, 112.14 U/L and 1.30 respectively. The mean value of SGOT was significantly higher than SGPT. The degree of rise of SGOT, SGPT, INR, Bilirubin and ALP was significantly more in DHF and DSS, as compared to DF. 28 patients (10%) had evidence of coagulopathy (INR >1.5) and 6 patients had evidence of hepatic encephalopathy. Conclusion:Liver dysfunction in the form of raised SGOT/SGPT was seen in almost all patients with rise in SGOT significantly more than SGPT. Preferentially high SGOT may serve as an early indicator of dengue infection while high values of bilirubin, SGOT, SGPT, ALP and INR may be an indicator of severe disease and poor prognosis.

Study of Hepatic Dysfunction in Dengue Fever: Does it Tell You the Prognosis?

“…This preferential elevation of AST over ALT was also noted in our study. Similarly, studies by de Souza LJ et al [22] , Chhina RS et al [20] and Soni A et al [12] also showed a greater elevation in AST than ALT levels.…”

“…Liver damage has been found to be more common among females in the large study from Brazil by de Souza LJ et al (74.6% of females vs 52.2% of males) [9] . However, studies by Soni A et al [12] and Bagepally RS et al [15] showed male preponderance (M:F ratio 2:1 and 2.5:1 respectively). Our study also showed slight overall male preponderance (M:F ratio 1.1:1) while the male to female ratio in patients with hepatic dysfunction was 2.8:1.…”

“…Autopsies of fatal cases have confirmed hepatocytes and Kupffer cells as the prime targets for DENV infection [5,10] . Pathogenesis of hepatic injury in dengue is primarily a T cell mediated process involving interaction between antibodies and the endothelium, cytokine storm (cytokine "Tsunami") and host factors like genetic polymorphisms [11,12] . The kinetics of liver enzyme elevation correlates with that of T-cell activation.…”

Hematological parameters and aminotransferase changes in dengue infection

“…DF initiates the inflammatory responses leading to liver parenchymal changes and causing release of transaminases in circulation [7,10] . In approximately 90% of the patients with DF, Aspartate Aminotransferase (AST) is higher than the Alanine Aminotransferase (ALT) [5,11] . We studied 100 patients with dengue that were admitted to Khaja Bandanawaz teaching and general hospital.…”

“…WHO 2018 report increase in number of cases from 2.2 million in 2010 to 3.2 million in 2015 [1] . Dengue virus was isolated in India for the first time in 1945 and poor hygiene and weaker health system are the factors for spread of the disease [5] . After an incubation period of 4-8 days, classical dengue fever presents as fever, generalized body ache, myalgia, arthralgia, and headache [6] .…”