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. 2016 May 4;94(5):1073-9.
doi: 10.4269/ajtmh.15-0507. Epub 2016 Mar 14.

Differences in Liver Impairment Between Adults and Children with Dengue Infection

Rosario Martínez Vega  1 , Weerapong Phumratanaprapin  2 , Benjaluck Phonrat  1 , Jittima Dhitavat  1 , Maleerat Sutherat  1 , Vorada Choovichian  1
Affiliations

Differences in Liver Impairment Between Adults and Children with Dengue Infection

Rosario Martínez Vega et al. Am J Trop Med Hyg. .

Abstract

Dengue infection (DI) is a major vector-borne disease in southeast Asia and an important cause of morbidity. The complications such as hepatic impairment are common, and because the physiology of the liver differs between children and adults, the DI-associated liver impairments might be expected to differ as well. This study aims to compare the differences in liver impairment between adults and children with DI. We retrospectively studied 158 adults and 79 children with serologically confirmed DI admitted to the Bangkok Hospital for Tropical Diseases from 2008 to 2012. In total, 93% of adults and 87% of children exhibited abnormal liver enzyme levels during hospitalization. Overall, 76 (42.4%) adults and 16 (20.3%) children had dengue hemorrhagic fever (DHF). Compared with children, adults with dengue fever (DF) presented a significantly higher incidence of liver function impairment (alanine transaminase [ALT] > 2 × upper limit of normal [ULN]) (47.1% versus 25.5%), hepatitis (ALT > 4 × ULN) (29.4% versus 12.8%), and severe hepatitis (aspartate transaminase [AST]/ALT > 10 × ULN) (16.5% versus 4.3%). Children with DHF showed a significantly higher incidence of liver function impairment due to AST derangement than did adults (100% versus 73%). There were no differences in the total bilirubin, albumin, or total protein levels between adults and children. Liver enzymes normalized significantly more slowly in adults, and AST recovery was faster than ALT. In conclusion, liver function impairment was more common among adults than children with DF. As the severity progressed to DHF, liver injury became more common in children.

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Figures

Figure 1.
Figure 1.
Patient enrollment.
Figure 2.
Figure 2.
Median aspartate transaminase (AST) and alanine transaminase (ALT) (U/L) among patients with dengue infection during hospitalization by age group.
Figure 3.
Figure 3.
Kaplan–Meier estimates of cumulative aspartate transaminase (AST) recovery over time in adults and children with dengue infection.
Figure 4.
Figure 4.
Kaplan–Meier estimates of cumulative alanine transaminase (ALT) recovery over time in adults and children with dengue infection.
See this image and copyright information in PMC

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