Clinical and laboratory findings in patients with dengue associated with hepatopathy

Abstract

Introduction: Hepatic disorders caused by dengue infection may progress to severe manifestations, including mortality and morbidity. Cytokines are involved in it, such as the migration inhibitory factor of macrophages (MIF), tumor necrosis factor (TNF), natural killer cells (NK), B lymphocytes, and macrophages. Methods: This study was carried out from January to April 2007 at a public hospital from the Federal University of Mato Grosso do Sul, Campo Grande, Brazil. Sixty-eight patients were studied concerning hepatic alterations, with 56 reported having classic dengue, 6 with hemorrhagic dengue grade I, and 6 with hemorrhagic dengue grade II. Results: Among the 56 with classic dengue, 83.3% had aspartate aminotransferase (AST) alterations, and 69.6% had altered alanine aminotransferase (ALT). For those with hemorrhagic dengue grade I, 100% had AST alterations, and 83.3% had altered ALT. All the patients with hemorrhagic dengue grade II had AST and ALT alterations. AST variations reached 22.0 and 907.0, with an average value of 164.6. For ALT, we found variations between 25.0 and 867.0, with an average value of 166.07. There had been statistical significance between dengue clinical shapes and hepatic function markers. Conclusions: We conclude that the infection was predominant in adults, females, and in those with low income and education. The liver enzymes were of larger amount in hemorrhagic dengue, but there was weak statistical evidence of the clinical manifestations and transaminases. Major signs and clinical symptoms were fever, headache, myalgia, arthralgia, weakness, severe pain behind the eyes, and rashes.

Dengue hemorrhagic fever and the liver

“…The elevation of AST and ALT appears to correlate with SDD[ 30 , 35 ]. Hypoalbuminemia has been reported in broad ranges from 35.3%-76.0% in several studies due to the population heterogeneity and the disease severity[ 16 , 20 , 27 - 29 ]. The meta-analysis conducted by Huy and colleagues revealed that hypoalbuminemia was significantly associated with DSS[ 35 ].…”

Liver involvement in dengue viral infections

“…Raised liver enzymes (aspartate transaminase [AST], alanine transaminase [ALT], alkaline phosphatase, and gamma‐glutamyl transferase [GT]) is the commonest feature of liver involvement . The elevation of liver enzymes is often modest.…”

“…13 Raised liver enzymes (aspartate transaminase [AST], alanine transaminase [ALT], alkaline phosphatase, and gamma-glutamyl transferase [GT]) is the commonest feature of liver involvement. [11][12][13][14] The elevation List of abbreviations: ADE, antibody-dependent enhancement; ALT, alanine transaminase; ALP, alkaline phosphatase; AST, aspartate transaminase; CAML, calcium-modulating cyclophilin ligand; CD, cluster of differentiation; cDNA, complementary DNA; DENV, dengue virus; DF, dengue fever; DHF, dengue haemorrhagic fever; DSS, dengue shock syndrome; DVI, dengue viral infection; ER, endoplasmic reticulum; ICAM, intercellular adhesion molecule; IL, interleukin; ISG, interferon-stimulated genes; GGT, gamma-glutamyl transferase; JAK/STAT, janus kinase/signal transducer and activator of transcription; L-SIGN, liver-specific ICAM3 grabbing nonintegrin; NAC, Nacetyl cystein; NF-kB, nuclear factor kB; NK cell, natural killer cell; NS, nonstructural (antigen); MAPK, mitogen-activated protein kinase; MMP, matrix metalloprotease; mRNA, messenger RNA; RANTES, regulated in activation, normal T cell expressed and secreted; RIPK, receptor-interacting protein kinase; TNF, tumour necrosis factor; TGF, transcription growth factor; TLR, Toll-like receptor; TRAIL, TNF-related apoptosis inducing ligand; Treg, regulatory T cell of liver enzymes is often modest. Mean AST and ALT levels ranged from 93.3 to 174 U/L and 86 to 88.5 U/L respectively in different studies.…”