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Dengue hepatitis with acute liver failure: Clinical, biochemical, histopathological characteristics and predictors of outcome
Author(s) -
Devarbhavi Harshad,
Ganga Deepak,
Me Mahesh,
Kothari Ksheetij,
Singh Rajvir
Publication year - 2020
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14927
Subject(s) - medicine , incidence (geometry) , gastroenterology , dengue fever , liver disease , dengue virus , epidemiology , hepatitis , bilirubin , mortality rate , serology , immunology , antibody , physics , optics
Background Hepatitis infection from non‐hepatotropic viruses such as dengue virus (DENV) is increasing worldwide. There is increasing recognition of the changing epidemiology and atypical presentations of DENV infection including acute liver failure (ALF). There is paucity of data regarding incidence, disease characteristics, and markers of prognosis in patients who develop DENV‐related ALF. Methods We aimed to study the incidence, clinical features, laboratory characteristics, and determinants of outcome in patients of DENV presenting with ALF. We reviewed all patients with DENV infection and focused on DENV‐related ALF from 2014 to 2017. Diagnosis of DENV and ALF was confirmed by serological tests and standard criteria, respectively. Results Thirty‐six patients (20 men, mean age 32.3) developed ALF among 10 108 patients with DENV infection (0.35%). Twenty‐one patients died (58.3%). Although bilirubin, aspartate and alanine aminotransferase, and international normalized ratio were markedly elevated in all patients with DENV ALF, there was no statistically significant difference between survivors and non‐survivors. Lactate levels, pH at admission, and model for end‐stage liver disease (MELD) score were the only predictors of mortality. Lactate levels were significantly higher in non‐survivors (11.5 ± 4.2 mmol/L) than survivors (6.3 ± 3.6 mmol/L) ( P < 0.001). MELD score in non‐survivors (26.7 ± 10.2) was significantly higher than in survivors (20 ± 7.2) ( P = 0.039). Receiver operator characteristic curve showed lactate or pH to be a superior prognostic marker than MELD with an area under the curve of 0.80, 0.79, and 0.70, respectively. Conclusion Dengue hepatitis progressed to ALF in 0.35%. Development of ALF was associated with a high mortality (> 50%). Lactate level, pH, and MELD score at admission were significant determinants of outcome.