Liver involvement associated with dengue infection in adults in Vietnam

Abstract

Globally, the number of adults hospitalized with dengue has increased markedly in recent years. It has been suggested that hepatic dysfunction is more significant in this group than among children. We describe the spectrum and evolution of disease manifestations among 644 adults with dengue who were prospectively recruited on admission to a major infectious disease hospital in southern Vietnam and compare them with a group of patients with similar illnesses not caused by dengue. Transaminase levels increased in virtually all dengue patients and correlated with other markers of disease severity. However, peak enzyme values usually occurred later than other complications. Clinically severe liver involvement was infrequent and idiosyncratic, but usually resulted in severe bleeding. Chronic co-infection with hepatitis B was associated with modestly but significantly increased levels of alanine aminotransferase, but did not otherwise impact the clinical picture.

Figure 1.

Box and whisker plots showing serial measurements of A, aspartate aminotransferase (AST) and B, alanine aminotransferase (ALT) levels in adults with confirmed dengue infection shown in groups according to the overall severity of vascular leakage and with results for the group with other febrile illnesses (OFI). Total number of patients included in each group is indicated. Forty-six of 644 dengue patients could not be classified for vascular leakage severity because of missing information and are not included. Cuzick test for trend was used to compare transaminase levels in each period across the three vascular leakage severity categories within the dengue patient group, *** P < 0.001 and ** P < 0.01. Boxes represent the median and interquartile values. Open circles indicate outlying values but extremes are not shown.