Liver function tests to predict the severity of dengue fever in serologically positive children below 18 years of age
DOI:
https://doi.org/10.18203/2349-3291.ijcp20190069Keywords:
Dengue fever, Liver dysfunction, Severe dengue feverAbstract
Background: Dengue fever presents with a diverse clinical spectrum. Although liver is not a major target organ, hepatic dysfunction is a well-recognized feature. In this study authors attempted to study the pattern of hepatic involvement in children with dengue and its association with disease severity.
Methods: This was a cross sectional study conducted at Cheluvamba hospital during the period of 1 year. Children <18 years of age with dengue Ns1 Ag and IgM positive were included in this study. After obtaining informed consent, a pre-structured proforma was used to record the relevant information from each subject. After detailed clinical examination and haematological investigation children were categorized into three groups as dengue fever with no warning signs (DNWS), dengue fever with warning signs (DWWS) and severe dengue fever (SDF) according to WHO classification. Statistical analysis was done to know the strength of association between different clinical and biochemical variables and outcome of the disease.
Results: The mean age of the study population was 8.65 years with male preponderance. The mean total bilirubin, serum albumin, SGOT, SGPT, ALP, PT and INR were 0.76 mg/dl, 3.8g/dl, 233.18U/L, 118.15U/L, 200.65 U/L, 12.9s and 1.09 respectively. The mean SGOT was significantly higher than SGPT. The degree of deranged LFTs was significantly more in SDF group than DNWS and DWWS groups. Serum albumin was significantly decreased in children with SDF group correlating with disease severity, prognosis and outcome.
Conclusions: Hepatic dysfunction was present in all forms of dengue infection, with SGOT rising significantly more than SGPT. All biochemical liver parameters were significantly deranged in patients with severe dengue fever indicating prolonged illness and poor prognosis.
References
NVDCP. National Guidelines for Clinical Management of Dengue Fever. 2014;20(3).
Rigau-Perez JG. The Early Use of Break-Bone Fever (Quebranta Huesos, 1771) and Dengue (1801) in Spanish. Am J Trop Med Hyg 1998;59(2):272-4.
Who. Handbook of Clinical Management Of Dengue Infection, Dengue Bulletin Southeast Region, Dec 2012;36(1).
Itha S, Kashyap R, Krishnani N, Sararswat Va, Choudhari G, Agarwal R. Profile of Liver Involvement In Dengue Virus Infection. Natl Med J India 2005;18(3):127-30.
Dengue: Guidelines for Patient care in the Region of The Americas. Washington DC. Paho 2016.
Kuno G. Emergence of the Severe Syndrome and Mortality Associated with Dengue And Dengue-Like Illness:Historical Records (1890 To 1950) and their compatibility with current hypotheses on the shift of disease manifestation. Clinical Microbiol Review. 2009;22(2):186-201.
Ranjit S, Kissoon N. Dengue Hemorrhagic Fever and Shock Syndromes. Pediatr Crit Care Med 2011;12(1):90-100.
Narayanan M, Arvind M A, Ambikapathy P. Dengue Fever-Clinical and Lab Parameters Associated With Complications. Dengue Bulletin; 2003. p27.
Kabilan L, Balasubramanian S, Keshava S M, Satyanarayana K. The 2001 Dengue Epidemic in Chennai. Indian J Pediatr 2005;72(11):919-23.
Jadhav R, Lohiya S, Agarkhedkar S, Lohakare A, Salunkhe S. Study of Dengue fever with special reference to predictors of spontaneous bleeding in Dengue Infection. J Pharm Biomed Sci 2015;5(11):851-6.
B Manohar, N Madhavi, B Sasikumar, Clinical profile and liver function inDengue. NIJP 2015;4(1).
Bokade CM., Urmila C, Kamat P. Study of Hepatic dysfunction in Dengue Fever and It’s Predictor of outcome. Int J Recent Scien Res. 2016;7(9):13360-3.
Mohan N, Goyal D, Karkra S, Perumal V. Profile of Dengue Hepatitis in Children from India and its correlation with WHO Dengue Case Classification. Asian Pac JTropical Dis 2017;7(6):327-31.
Oishia K, Mapuae CA, Carlosd CC, Maria TDD, Abanesd C, Saitob M, et al. Dengue and other febrile illness among children in Philippines. Dengue Bulletin 2006;30.
Ahmed S. Dengue Fever outbreak in Karachi 2006-A study of profile and outcome of children under 15 years of age. JPMA 2008;58(1):4.
Uddin F. Dengue and Dengue Haemorrhagic Fever in Children in Outbreak Chittagong, Bangladesh. Dengue Bulletin 2001;25.
Roy A, Sarkar D, Chakraborty S, Chaudhuri J, Ghosh P, Chakraborty S. Profile of hepatic involvement by Dengue virus in Dengue infected children. N Am J Med Sci. 2013;5(8):480-5.
Jagadish K, Puja J. Hepatic involvement in Dengue fever in children. Iranian J Pediat 2012;22(2):231-6.
Gowda S, Desai PB, Hull VV, Math AAK, Vernekar SN, Kulkarni SS. A review on laboratory Liver Function Tests. Pan Afr Med J 2009;3:17.
Chhina RS, Goyal O, Chhina DK, Goyal P, Kumar R, Puri S. Liver Function Tests in patients with Dengue viral infection. Dengue Bulletin 2008;32:110-7.
Patil A, Maajigoudar SS. Liver Profile in Dengue Fever. 2012;60-71.
Brito Carlos AA, Maria De Fátima MP, Lucena-Silva Norma. Plasma Leakage Detection In Severe Dengue: When Serum Albumin Quantification Plays A Role. Rev Soc Bras Med Trop. 2007;40(2).
Ahmed A, Alvi AH, Butt A, Nawaz AA, Hanif A. Assessment of Dengue Fever severity through Liver Function Tests. J Coll Physicians Surg Pak. 2014;24(9):640-4.
