Predicting acute liver failure in dengue infection.

R S Kumarasena,A S Dassanayaka,C K Ranawaka,J K N D Miththinda,H J De Silva,A P De Silva,M A Niriella

doi:10.4038/cmj.v61i1.8260

R S Kumarasena, A S Dassanayaka + Show 5 more

Open Access

https://doi.org/10.4038/cmj.v61i1.8260

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Abstract

In a retrospective study involving 240 patients with dengue infection, we attempted to identify early predictors of acute liver failure (ALF). Sixteen out of 41 patients with serum AST more than 1000 IU/ml developed ALF compared to none with serum AST less than 1000 IU/ml. Among patients with serum AST more than 1000 IU/ml, presence of two of the three following phenomena, within the first 5 days of illness: elevated serum bilirubin, elevated alkaline phosphatise or persistent nausea and vomiting, predicted development of ALF (93.8% sensitivity, 98.7% specificity, 83.3% positive predictive and 99% negative predictive value). The presence of elevated serum bilirubin, alkaline phosphatase and persistent nausea and vomiting in patients with very high serum AST during the early phase of dengue infection should alert the physician of impending ALF.

Highlights

Dengue virus infection (DI) is endemic in Sri Lanka
In a retrospective cohort study we attempted to identify early predictors of acute liver failure (ALF) in patients admitted to hospital with DI confirmed by dengue IgM antibodies detected by ELISA technique on day six or later
The case fatality rate in DI with associated ALF has been reported to be as high as 50% [3]

Summary

Introduction

Dengue virus infection (DI) is endemic in Sri Lanka. Organ specific complications such as myocarditis and acute liver failure (ALF) occur more frequently now. Hepatic dysfunction in DI is attributed either to a direct viral effect on hepatocytes or a dysregulated host immune response to the virus. Infection with dengue serotypes DENV 2, 1 and 3, respectively, correlate with decreasing severity of liver damage as evidenced by elevation of transaminases [1]. Identification of impending ALF in DI will help clinicians to identify patients who will benefit from interventions such as intravenous N-acetyl cysteine (NAC) [4].

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