Incidence and Clinical Outcome of Acute Liver Failure Caused by Dengue in a Hospital for Tropical Diseases, Thailand

Khin Kye Mon Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

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Apichart Nontprasert Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

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Chatporn Kittitrakul Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

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Pisit Tangkijvanich Research Unit of Hepatitis and Liver Cancer, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

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Wattana Leowattana Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

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Kittiyod Poovorawan Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

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Abstract

Acute liver failure is an atypical manifestation of dengue with a high mortality. We performed a retrospective cohort study at the Hospital for Tropical Diseases, Bangkok, Thailand. In total, 1,926 patients with serologically confirmed dengue were enrolled in the study from 2011 to 2015. Of these, six patients presented with acute liver failure, four died, and two survived. The incidence of dengue-associated acute liver failure was 0.31%. Dengue-associated acute liver failure was most common among young adults (median age, 29 years). The median duration from onset of fever to development of acute liver failure was 7.5 days. Patients with the severe stage of dengue had a higher risk of developing acute liver failure (P < 0.001). The baseline risk factors associated with the development of acute liver failure were an age of ≤ 40 years (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.1–2.0, P < 0.05), a > 10% ratio of atypical lymphocytes (OR = 2.3, 95% CI = 1.8–3.0, P < 0.001), and a platelet count of < 50,000 mm3 (OR = 2.8, 95% CI = 2.2–3.6, P < 0.001). The incidence of acute liver failure in patients with dengue was quite low, but its impact on morbidity, mortality, and poor clinical outcomes was significant. In summary, this study indicates that various baseline risk factors are associated with acute liver failure in patients with dengue.

Author Notes

* Address correspondence to Kittiyod Poovorawan, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Rachavithee Road, Bangkok 10400, Thailand. E-mail: kittiyod.poo@mahidol.ac.th

Financial support: This work was supported by the Faculty of Tropical Medicine, Mahidol University.

Authors' addresses: Khin Kye Mon, Apichart Nontprasert, Chatporn Kittitrakul, Wattana Leowattana, and Kittiyod Poovorawan, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, E-mails: julymirrormn9@gmail.com, apichart.non@mahidol.ac.th, chatporn.kit@mahidol.ac.th, wattana.leo@mahidol.ac.th, and kittiyod.poo@mahidol.ac.th. Pisit Tangkijvanich, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, E-mail: pisittkvn@yahoo.com.

  • 1.

    Malavige GN, Fernando S, Fernando DJ, Seneviratne SL, 2004. Dengue viral infections. Postgrad Med J 80: 588601.

  • 2.

    Villar LA, Rojas DP, Besada-Lombana S, Sarti E, 2015. Epidemiological trends of dengue disease in Colombia (2000–2011): a systematic review. PLoS Negl Trop Dis 9: e0003499.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    World Health Organization, 2009. Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control. Geneva, Switzerland: World Health Organization.

  • 4.

    Nimmagadda SS, Mahabala C, Boloor A, Raghuram PM, Nayak U, 2014. Atypical manifestations of dengue fever (DF): where do we stand today. J Clin Diagn Res 8: 7173.

  • 5.

    Polson J, Lee WM, American Association for the Study of Liver Diseases, 2005. AASLD position paper: the management of acute liver failure. Hepatology 41: 11791197.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Lee WM, Larson AM, Stravitz RT, 2011. AASLD Position Paper: The Management of Acute Liver Failure: Update 2011. Alexandria, VA: American Association for the Study of Liver Diseases.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Trung DT, Thao Le TT, Hien TT, Hung NT, Vinh NN, Hien PT, Chinh NT, Simmons C, Wills B, 2010. Liver involvement associated with dengue infection in adults in Vietnam. Am J Trop Med Hyg 83: 774780.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Itha S, Kashyap R, Krishnani N, Saraswat VA, Choudhuri G, Aggarwal R, 2005. Profile of liver involvement in dengue virus infection. Natl Med J India 18: 127.

  • 9.

    Gasperino J, Yunen J, Guh A, Tanaka KE, Kvetan V, Doyle H, 2007. Fulminant liver failure secondary to haemorrhagic dengue in an international traveller. Liver Int 27: 11481151.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Tan SS, Bujang MA, 2013. The clinical features and outcomes of acute liver failure associated with dengue infection in adults: a case series. Braz J Infect Dis 17: 164169.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Parkash O, Almas A, Jafri SM, Hamid S, Akhtar J, Alishah H, 2010. Severity of acute hepatitis and its outcome in patients with dengue fever in a tertiary care hospital Karachi, Pakistan (south Asia). BMC Gastroenterol 10: 43.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Squires RH, 2008. Acute liver failure in children. Semin Liver Dis 28: 153166.

  • 13.

    Gotthardt D, Riediger C, Weiss KH, Encke J, Schemmer P, Schmidt J, Sauer P, 2007. Fulminant hepatic failure: etiology and indications for liver transplantation. Nephrol Dial Transplant 22 (Suppl 8): viii5viii8.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Gill RQ, Sterling RK, 2001. Acute liver failure. J Clin Gastroenterol 33: 191198.

  • 15.

    Vinodh B, Bammigatti C, Kumar A, Mittal V, 2005. Dengue fever with acute liver failure. J Postgrad Med 51: 322.

  • 16.

    Kuo CH, Tai DI, Chang-Chien CS, Lan CK, Chiou SS, Liaw YF, 1992. Liver biochemical tests and dengue fever. Am J Trop Med Hyg 47: 265270.

  • 17.

    Nguyen TL, Nguyen TH, Tieu NT, 1997. The impact of dengue haemorrhagic fever on liver function. Res Virol 148: 273277.

  • 18.

    American Gastroenterological Association, 2002. American Gastroenterological Association medical position statement: evaluation of liver chemistry tests. Gastroenterology 123: 13641366.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Kim TY, Kim DJ, 2013. Acute-on-chronic liver failure. Clin Mol Hepatol 19: 349359.

  • 20.

    Buchman AL, Iyer K, Fryer J, 2006. Parenteral nutrition–associated liver disease and the role for isolated intestine and intestine/liver transplantation. Hepatology 43: 919.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Yung CF, Lee KS, Thein TL, Tan LK, Gan VC, Wong JG, 2015. Dengue serotype-specific differences in clinical manifestation, laboratory parameters and risk of severe disease in adults, Singapore. Am J Trop Med Hyg 92: 9991005.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Sedhain A, Adhikari S, Regmi S, Chaudhari SK, Shah M, Shrestha B, 2011. Fulminant hepatic failure due to dengue. Kathmandu Univ Med J 9: 7375.

  • 23.

    Treeprasertsuk S, Kittitrakul C, 2015. Liver complications in adult dengue and current management. Southeast Asian J Trop Med Public Health 46 (Suppl 1): 99107.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Senaratne T, Carr J, Noordeen F, 2016. Elevation in liver enzymes is associated with increased IL-2 and predicts severe outcomes in clinically apparent dengue virus infection. Cytokine 83: 182188.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Thomas SJ, Endy TP, 2011. Vaccines for the prevention of dengue: development update. Hum Vaccin 7: 674684.

  • 26.

    Tang KF, Ooi EE, 2012. Diagnosis of dengue: an update. Expert Rev Anti Infect Ther 10: 895907.

  • 27.

    Sinha G, 2014. Sanofi's dengue vaccine first to complete phase 3. Nat Biotechnol 32: 605606.

  • 28.

    Hadinegoro SR, Arredondo-Garcia JL, Capeding MR, Deseda C, Chotpitayasunondh T, Dietze R, Muhammad Ismail HI, Reynales H, Limkittikul K, Rivera-Medina DM, Tran HN, Bouckenooghe A, Chansinghakul D, Cortes M, Fanouillere K, Forrat R, Frago C, Gailhardou S, Jackson N, Noriega F, Plennevaux E, Wartel TA, Zambrano B, Saville M, CYD-TDV Dengue Vaccine Working Group, 2015. Efficacy and long-term safety of a dengue vaccine in regions of endemic disease. N Engl J Med 373: 11951206.

    • PubMed
    • Search Google Scholar
    • Export Citation
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