Abstract
Background Deranged liver is a well-recognized feature of dengue infection, often demonstrated by coagulopathy and mild to moderate increase in transaminase levels although jaundice and fulminant hepatic failure are generally uncommon. Objective This study aimed to evaluate the hepatic effect of dengue fever amongst Sudanese patients.Materials and Methods A cross-sectional descriptive study recruited in Port Sudan teaching hospital in the period from February 2013 to June 2014. 334 cases of dengue along with 101 cases of control were enrolled. Rapid immune chromatographic test was used to confirm positive dengue cases and WHO criteria were used for classifying the dengue severity. Prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen level (FB), platelet count (PLT), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and C-reactive protein (CRP) were all measured. Results PT, PTT, and FB were found to be significantly higher in the infected cohort when compared to the controls (P< 0.0001). PT was prolonged in 9%, PTT was prolonged in 12.6% and shortened by 5.4% of the patients, whereas hypofibrinogenemia in 18.3% and hyperfibrinogenemia in 67.4% of the patients. Bleeding was seen in 10.5% of patients and thrombocytopenia was detected in 83.5% of patients. Out of 334 patients, 101 (30.2%) had abnormal coagulation results. Of 101 patients, 72 were subjected mixing studies for PT and PTT that revealed deficiencies in factors VIII (35%), IX (10%), V (10%), X (19%), and XII (14%). 43.6% patients had elevated AST and 21.8% had elevated ALT.ConclusionThis study demonstrated that hepatic dysfunction may be attributed to dengue virus infection which evident by prolongation in PT and PTT as well as hypofibrinogenemia and factor deficiencies.
Highlights
Dengue virus has recently become a major public health concern, in tropical and subtropical countries, predominantly in urban and periurban areas [1]
The resurgence of dengue has been observed in Port Sudan, Red Sea State, Sudan and dengue outbreak have been frequently reported from different part of the State in both urban and rural populations [3, 4]
This study was conducted to evaluate the variations of liver dysfunction by measuring the level of the liver enzymes, prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen (FB) level and coagulation mixing studies
Summary
Dengue virus has recently become a major public health concern, in tropical and subtropical countries, predominantly in urban and periurban areas [1]. Hepatic dysfunction in dengue infection may be attributed to direct viral effect on liver cells or as a consequence of dysregulation host immune responses against the virus [7]. This study was conducted to evaluate the variations of liver dysfunction by measuring the level of the liver enzymes, prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen (FB) level and coagulation mixing studies. The significance of this study is the importance of measuring the liver enzymes in the patients with dengue virus infection. Deranged liver is a well-recognized feature of dengue infection, often demonstrated by coagulopathy and mild to moderate increase in transaminase levels jaundice and fulminant hepatic failure are generally uncommon. Conclusion: This study demonstrated that hepatic dysfunction may be attributed to dengue virus infection which evident by prolongation in PT and PTT as well as hypofibrinogenemia and factor deficiencies
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