Liver function in dengue and it's correlation with disease severity: an retrospective cross-sectional observational study in a tertiary care center in Coastal India

Swamy, Anusha Mruthyunjaya; Mahesh, P; Tumkur, Sujith Rajashekar

doi:10.11604/pamj.2021.40.261.29795

Cited by 16 publications

(27 citation statements)

References 22 publications

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“…Previous studies have shown that elevations in AST/ ALT although significant in severe disease did not affect the outcome including mortality. 14 In our study, the median platelet count was observed to be significantly low in those with liver injury (p < 0.001), and similar observation has been previously reported by Swami et al 15 As dengue infection is associated with thrombocytopenia and bleeding diathesis, there is a possibility that liver injury may accelerate the disease progression as liver is the major source of prothrombin and vitamin K, which are required in the clotting cascade mechanism. Liver dysfunction has been studied previously in dengue patients, but the pattern of liver involvement and liver injury has not been described.…”

Section: Discussionsupporting

confidence: 89%

The continuum of liver injury with severity of dengue fever: A retrospective observational study

Mohindra,

Kalyan

et al. 2023

Journal of the Royal College of Physicians of Edinburgh

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Introduction: Dengue is a major international health concern prevalent in tropical and sub-tropical countries. There are a paucity of studies on the relationship of hepatic complications with inflammatory parameters in dengue infection. Patients and methods: Single-centre observational study was conducted at the tertiary care centre in North India. Patients (>12 years) diagnosed with dengue infection between August and November 2021 were enrolled in the study. The frequency of hepatic derangements and their associations with inflammatory severity was analysed. Results: Based on the clinical symptoms, 170 patients were classified into three categories, namely, dengue fever, warning dengue and severe dengue. Higher incidence of liver dysfunction was observed in severe dengue patients with median values of aspartate aminotransferase (AST) (3051 U/L, p < 0.001), alanine aminotransferase (ALT) (1792 U/L, p = 0.009), alkaline phosphatase (172 U/L, p = 0.001), T.Bil (34.2 µmol/L, p < 0.001), albumin (30 g/L, <0.001), and gamma-glutamyl transferase (152 U/L, p < 0.001) along with inflammatory marker C-reactive protein (CRP) (43 mg/dL, p < 0.001) highly deranged, in comparison to patients with/without warning signs. Median levels of CRP were found to be positively and significantly correlated with the median levels of AST and ALT ( p < 0.05, r = 0.99) in all three categories of dengue patients. Liver injury was noted in 107 (63%) of the cohort, and mixed type of liver injury involving both hepatocellular and cholestatic patterns was observed as the most common type of injury ( n = 50, 29.4%). Liver injury correlated with the severity of dengue illness as about 85% of severe dengue patients had significant liver injury ( p = 0.014). Conclusion: In dengue patients, the association of the liver injury with inflammatory severity suggests that the mechanism of liver injury may be related to inflammatory response apart from the hepatotropic nature of the virus.

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Section: Discussionsupporting

confidence: 89%

The continuum of liver injury with severity of dengue fever: A retrospective observational study

Mohindra,

Kalyan

et al. 2023

Journal of the Royal College of Physicians of Edinburgh

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“…No significant difference was observed in the ratio of the abnormal serum LDH, TBIL, and DBIL ( P > 0.05; Table 7 ). All the patients enrolled in this study had no history of digestive system disorders, and elevated liver transaminase levels may indicate the liver dysfunction among COVID-19 patients [ 18 , 19 ]. Our study indicated that the inactivated vaccines might prevent Delta variant-induced liver dysfunction.…”

Section: Resultsmentioning

confidence: 99%

Real-World Evidence for COVID-19 Delta Variant’s Effects on the Digestive System and Protection of Inactivated Vaccines from a Medical Center in Yangzhou, China: A Retrospective Observational Study

Zhao

Xie

et al. 2022

International Journal of Clinical Practice

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Background. Coronavirus disease 2019 (COVID-19) is rapidly disseminated worldwide, and it continues to threaten global public health. Recently, the Delta variant has emerged as the most dreaded variant worldwide. COVID-19 predominantly affects the respiratory tract, and studies have reported the transient effects of COVID-19 on digestive system function. However, the relationship between the severity of the Delta variant and digestive system function remains to be investigated. Additionally, data on the ability of the inactive Chinese vaccines (Sinovac or Sinopharm) to protect against the Delta variant or COVID-19-induced gastrointestinal symptoms in the real world are insufficient. Thus, the present retrospective observational study first attempted to use the total gastrointestinal symptom rating scale scores (GSRS) to quantify the possible changes in digestive system functions following the Delta variant infection in the early stage. In addition, the study discusses the potential of inactivated vaccines in preventing severe or critical symptoms or Delta variant-induced digestive system dysfunction. Methods. To evaluate the difference between mild illness group, moderate illness group, and severe or critical illness group, analysis of variance (ANOVA) was employed to compare the three groups' total gastrointestinal symptom rating scale scores (GSRS). A chi-squared test was used to compare the differences in the ratio of the abnormal biochemical measurements among the three groups first. Then, the percentage of the vaccinated population was compared among the three groups. Additionally, the ratio of the abnormal serum markers between the vaccinated and nonvaccinated cohorts was compared. A P value < 0.05 was considered statistically significant. Results. Significant differences were observed in the abnormal ratio of alanine aminotransferase (ALT), total bilirubin (TBIL), direct bilirubin (DBIL), lactate dehydrogenase (LDH), and Interleukin 6 (IL-6) ratio among the three groups ( P < 0.05 ). Additionally, no significant difference was observed in the abnormal serum markers ratio between day 14 and day 21 after treatment ( P > 0.05 ). A significant difference was observed in the total GSRS scores among the three groups and the ratio of the vaccinated population among the three groups ( P < 0.05 ). A significant difference was observed in the ratio of the abnormal serum ALT and AST levels between the vaccinated and nonvaccinated cohorts ( P < 0.05 ). Conclusions. In summary, serum AST, DBIL, LDH, and IL-6 levels are potential markers for distinguishing severe or critical patients in the early stage of the Delta variant infection. Additionally, changes in the levels of these serum makers are transient, and the levels can return to normal after treatment. Furthermore, severe gastrointestinal discomfort was significantly more prevalent in patients with severe or critical diseases and should thus be considered in patients diagnosed with Delta variant infection. Finally, inactivated vaccines may prevent severe or critical symptoms and Delta variant-induced liver dysfunction. Vaccination programs must be promoted to protect public health.

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“…Liver involvement is prevalent among people infected with Dengue virus, most commonly founded in the form of elevated transaminase levels. Escalating levels of serum glutamic-oxaloacetic transaminase and serum glutamic-pyruvic transaminase are in corollary to disease severity and are indirectly proportional to platelet counts [10]. Concomitant complains of abdominal pain, anorexia, nausea and vomiting are strong indicators of liver involvement in a diagnosed dengue patient [11].…”

Section: Discussionmentioning

confidence: 99%

Case report: Acute Liver failure; An Unusual Complication of Dengue Fever

Uzair

Waseem

Kumar

et al. 2023

Preprint

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Liver function in dengue and it's correlation with disease severity: an retrospective cross-sectional observational study in a tertiary care center in Coastal India

Cited by 16 publications

References 22 publications

The continuum of liver injury with severity of dengue fever: A retrospective observational study

The continuum of liver injury with severity of dengue fever: A retrospective observational study

Real-World Evidence for COVID-19 Delta Variant’s Effects on the Digestive System and Protection of Inactivated Vaccines from a Medical Center in Yangzhou, China: A Retrospective Observational Study

Case report: Acute Liver failure; An Unusual Complication of Dengue Fever

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