Clinical Profile, Hepatic Dysfunctions, and Outcome of Dengue Patients in a Tertiary Care Hospital of Eastern India.

BACKGROUND

Dengue is one of the commonest tropical infections in India. This study was aimed to evaluate clinical profile, magnitude and spectrum of hepatic dysfunctions, outcome and clinical predictors of mortality in patients with dengue.

METHODS

In an observational study, data of 183 consecutive admitted dengue patients were prospectively collected. The magnitude of hepatitis and its association with outcome were studied.

RESULTS

The transaminases elevation was seen in 156 (85%) patients, with 21 (11.4%) patients had levels above 10 times the upper normal limit (UNL). Aspartate aminotransferase (AST) showed greater elevation as compared to Alanine aminotransferase (ALT) in 136 (87%) patients. Patients who died (n=8), compared with those who survived (n=175) had higher mean serum bilirubin (3.4 vs. 0.7 mg/dl, p= 0.01), median AST (8791 vs. 138 IU/L, p=0.02), median ALT (2692 vs 81 IU/L, p=0.02), median serum creatinine (2.0 vs 1.0 mg/dl, p=0.007), mean International normalized ratio (3.5 vs 1.1, p= 0.04), and lower median platelet count (20000 vs 60000/mm3, p <0.001). Among patients who died 87.5% (n= 7) had AST levels greater than 100 times UNL while among patients who survived 93% (n=162) had AST levels lower than 10 times UNL. In a multivariate analysis, serum bilirubin (≥2.2 mg/dl, OR 4.8) and creatinine (≥1.65 mg/dl, OR 2.8) were found to be independent predictors of mortality.

CONCLUSIONS

Hepatitis is very frequent in patients with dengue. AST elevation is usually more than ALT elevation. Presence of jaundice and renal dysfunction at presentation are ominous signs in predicting mortality.