Kulkarni Anand V, Choudhury Ashok K, Premkumar Madhumita, Jain Priyanka, Gupta Ekta, Sarin Shiv Kumar
Department of Hepatology and Transplant, Institute of Liver and Biliary Sciences, New Delhi, India.
Department of Statistics, Institute of Liver and Biliary Sciences, New Delhi, India.
J Clin Transl Hepatol. 2019 Jun 28;7(2):106-111. doi: 10.14218/JCTH.2018.00047. Epub 2019 May 9.
Dengue infection is a major health burden, which can result in mild self-limited febrile illness to highly fatal hemorrhagic disease. There is paucity of literature describing the manifestations of dengue in patients with underlying liver disease. We studied and compared the manifestations of this tropical infection in patients with and without liver disease. Patients with serologically-confirmed dengue infection were included in this retrospective study, obtained for over a period of 1 year. Demographic and laboratory variables were compared for the individuals with no underlying liver disease (Group A, = 71), chronic hepatitis (Group B, = 12), and cirrhosis (Group C, = 12). Males predominated the study population (61%), with a higher mean age in the cirrhotic group. The most common clinical manifestation was classical dengue fever, seen in 89 individuals. Two presented as dengue hemorrhagic fever (1 each in Group A and Group B), 1 presented as acute liver failure, and 3 as acute-on-chronic liver failure. Hemoconcentration was less evident in Group C as compared to Group A and Group B ( < 0.001). Patients in Group C had significantly prolonged International Normalized Ratio (INR) and enhanced thrombocytopenia compared to patients in Group A and Group B. Patients in Group C also required prolonged hospital stay (Group A: 4.83 ± 2.88, Group B: 7.33 ± 2.3, Group C: 13 ± 5 days; < 0.001). Three patients expired in Group C compared to the 1 in Group A and none in Group B ( = 0.01). On univariate analysis, hemoglobin, albumin, INR, and bilirubin predicted development of liver failure. On multivariate analysis, INR and bilirubin predicted development of liver failure. Dengue infection can have varied manifestations, ranging from simple fever to acute-on-chronic liver failure and acute liver failure. Cirrhotic patients lack classical features of dengue and have relatively poor prognosis. Dengue should be suspected as a cause of liver failure in endemic areas, where no etiological cause is discernible.
登革热感染是一项重大的健康负担，可导致从轻度自限性发热疾病到高度致命的出血性疾病。关于潜在肝病患者登革热表现的文献较少。我们研究并比较了有肝病和无肝病患者中这种热带感染的表现。本回顾性研究纳入了血清学确诊的登革热感染患者，研究时间超过1年。比较了无潜在肝病个体（A组，n = 71）、慢性肝炎患者（B组，n = 12）和肝硬化患者（C组，n = 12）的人口统计学和实验室变量。男性占研究人群的大多数（61%），肝硬化组的平均年龄较高。最常见的临床表现是典型登革热，89例患者出现该症状。2例表现为登革出血热（A组和B组各1例），1例表现为急性肝衰竭，3例表现为慢加急性肝衰竭。与A组和B组相比，C组的血液浓缩不太明显（P < 0.001）。与A组和B组患者相比，C组患者的国际标准化比值（INR）显著延长，血小板减少更严重。C组患者的住院时间也更长（A组：4.83±2.88天，B组：7.33±
