Association between the degree of hepatic dysfunction and complications among serologically positive and serologically negative dengue infection in children

Abstract

Objective: To analyze the degree of liver dysfunction among serologically confirmed dengue and dengue suspected cases as per the WHO criteria in children with reference to complications and mortality. Methods: This study was conducted on 200 children between 3 months to 15 years age group, admitted with acute febrile illness during an outbreak of dengue infection. Clinically suspected dengue based on WHO criteria and serologically confirmed dengue patients were included in the study. Liver function tests were analyzed and evaluated the degree of liver damage to assess the outcome, mortality and prognosis of dengue infection. Results: Of the 200 acute febrile patients enrolled in the study, 105 (52.5%) were classified as serologically confirmed dengue, out of which 64(61%) were Dengue fever (DF) and 41(39%) were Dengue hemorrhagic fever (DHF). 95 (47.5%) were classified as suspected dengue cases, as per the WHO diagnostic criteria, out of which 54 (56.8%) were DF and 41 (43.9%) were DHF. There was severe elevation of aspartate transaminase (AST) and alanine transaminase (ALT) in both confirmed DHF (mean 452.6U/l and 210U/l) and suspected DHF (mean 694U/l and 431U/l), moderate elevation in confirmed DF (mean 286.7U/l and 162.5 U/l) and mild elevation in suspected DF (mean 80.2U/l and 48.1U/l). The AST levels were significantly elevated than the ALT levels in both confirmed and suspected cases of DF and DHF. Hepatic dysfunction was more common in confirmed dengue (66%) cases than suspected dengue (57.6%). The common degree of liver damage both in confirmed and suspected cases of DF was grade 0 where as in DHF grade 1. All the patients with encephalopathy had grade 4 liver damage. Dengue complicated by renal failure had grade 3 and 4 liver damage. There was a significantly higher mortality rate in DHF with grade 4 hepatic damage than DF. Conclusion: The degree of liver dysfunction is more significant in both serologically positive and negative DHF than DF. Severe hepatitis (grade 3 and 4) in dengue infection has got worse outcome in terms of mortality and complications as compared to mild to moderate hepatitis (grade 1 and 2). Therefore severe hepatitis can be considered as a bad prognostic indicator of outcome in dengue infection.