Hepatocellular Damage in the Patients presenting with Dengue Fever
Background: Dengue fever is becoming endemic in Pakistan as shown by its increasing prevalence in the summer seasons for almost the last decade. Elevation of liver enzymes indicating underlying liver damage, is a common phenomenon and may be associated with other complications.
Objective: To find out the frequency of hepatocellular damage in the patients presenting with dengue fever as evident by elevated liver enzymes.
Material and Methods: This was a descriptive study performed in the medical unit of Hayatabad Medical Complex Peshawar Pakistan. Patients were consecutively collected from the wards, outpatients, and emergency department. The patient's collection was from the year 2022 epidemic from 10th Jul to 23rd Oct. Patients with consistent clinical features, were diagnosed on the bases of dengue NS1 test and antibodies titers. Liver enzymes, complete blood counts and ultrasound were performed to find out any evidence of liver damage and plasma leaks as evident by pleural effusion or ascites. Alanine aminotransferase (ALT) of more than 50 U/L was considered as elevated in our study. Patients with elevated liver enzymes due to expected reasons other than dengue fever as per clinical records, were excluded from the study. The patient's data was noted on a preformed Performa for further analysis.
Results: We consecutively collected 500 patients for the study. The number of male patients was 59% (n=295) while female patients were 41% (n=205). The age range was 15 to 75 years (mean 45, SD 21.32). The overall frequency of elevated (ALT) was 68.2% (n=341). Stratification of patients according to the ALT level shows that only 13.68% were having an ALT level of more than 300 U/L. The frequency was 45.45% in patients without complications, 91.60% in patients with warning signs, 85.71% in severe dengue and 100% with acute liver failure. Patients with an alanine aminotransferase (ALT) of =>300U/L were having a hospital stay of 5 to 12 days (mean 8.81, SD 2.6) days verses 4 to 9 days (mean 5.8, SD 1.9) in the patients having <300U/L
Conclusion: Most of the patients with dengue fever have elevated alanine aminotransferase level indicative of underlying hepatocellular damage. Such patients usually recover without any serious consequences except those having elevation of 300U/l or more whose hospital stay was prolonged, and a smaller percentage was associated with acute liver failure.
Keywords: dengue fever, dengue NS1, hepatocellular damage, liver enzymes, hospital stay.
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