Prevalence of hepatic dysfunction in children with dengue fever

Abstract

Background:Dengue is one disease entity with different clinical presentations and often with unpredictable clinical evolution and outcome. The degree of liver dysfunction in children with dengue infection varies from mild injury with elevation of transaminases to severe injury with jaundice and liver cell failure. This study was undertaken to find the prevalence of hepatic dysfunction in children admitted with Dengue fever. Methods:All children with serologically (dengue NS1 antigen detection and/or dengue IgM Mac ELISA) confirmed dengue fever aged between 2 months and 12 years were included in the study. Children with other etiologies of hepatitis were excluded. Liver function tests including bilirubin, transaminases and prothrombin time (PT) were done. Prevalence and severity of hepatic dysfunction were statistically analysed and compared between different categories of dengue fever severity. Results:Hepatic dysfunction was present in 35 (67.30%) of the 52 children included in the study.About 85.71% of the children with dengue fever in the age group of 2 months to 1 year had hepatic dysfunction. In children with severe dengue, 83.3% had hepatic dysfunction.Raised liver enzymes in 32(61.53%), hepatomegaly in 21(40.48%), INR≥1.5 in 8(15.38%) and jaundice in 1(1.92%) children were the manifestations. None of the patients had acute hepatic failure or hepatic encephalopathy.Association of hepatomegaly with increasing disease severity was statistically significant (p = 0.0262). Hepatic dysfunction was present in 83.33% and 87.5% of children with abdominal pain and clinical fluid accumulation respectively. Of the 32 patients (61.53%) with elevated transaminases, 18 (51.42%) had elevated levels of AST alone, 40% had elevation of AST and ALT both. Conclusions: The prevalence of hepatic dysfunction among children with dengue fever is 67.30%, more commonly observed in severe forms of dengue. Spectrum of hepatic involvement ranges from raised liver enzymes without jaundice to clinically evident jaundice. Hepatic dysfunction is commonly observed in children with abdominal pain and clinical fluid accumulation.