Predicting acute liver failure in dengue infection

Kumarasena, Ravindu S.; Niriella, Madunil Anuk; Ranawaka, CK; Miththinda, J.K.N.D.; Silva, A P De; Dassanayaka, A.S.; Silva, H J de

doi:10.4038/cmj.v61i1.8260

Cited by 11 publications

(9 citation statements)

References 3 publications

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“…Regarding the liver biochemistry, the mean levels of bilirubin, transaminases, and alkaline phosphatase were higher in the ALF group than in the non-ALF group, which was in accordance with findings from previous studies[ 7 , 12 , 14 , 17 ]. The degree of transaminase elevation in our study was relatively higher than that in other studies[ 11 , 18 ] (15-20 times the normal level); however, we did not find an association between the presence of extremely high transaminase levels or increasing levels of other biochemistry outcomes and the development of ALF from DISH.…”

Section: Discussionsupporting

confidence: 92%

Acute liver failure and death predictors in patients with dengue-induced severe hepatitis

Teerasarntipan¹,

Chaiteerakij²,

Komolmit³

et al. 2020

WJG

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BACKGROUND Liver injury in patients with dengue infection is common. Most patients have mild and transient hepatitis. Acute liver failure (ALF) in dengue infection is rare but results in an extremely poor prognosis. AIM To identify prognostic predictors of ALF and death in patients with dengue-induced severe hepatitis (DISH). METHODS We retrospectively reviewed 2311 serologically confirmed adolescent and adult dengue patients who were hospitalized during a 12-year study period (between 2007 and 2019) at the university hospital of King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Patients with DISH [ n = 134 (5.80%)], defined as a baseline transaminase > 10 times the normal reference cut-off level, and DISH with subsequent ALF as defined by the American Association for the Study of the Liver Diseases 2011 criteria [ n = 17 (0.74%)], were included. Predictors of ALF and in-hospital death were identified using logistic regression analysis. RESULTS Of the 151 dengue-infected patients with severe liver injury or ALF, 51% were female, with a mean age of 27.9 ± 14.5 years. Capillary leakage syndrome (CLS) occurred in 68.2% ( n = 103) of DISH and 100% of ALF patients. The mortality rate was low in DISH patients (0.8%) but was remarkably high if ALF developed (58.8%). In univariate analysis, age, sex, hematocrit, white blood count, atypical lymphocyte count, platelet count, international normalized ratio (INR), bilirubin, serum glutamate-oxaloacetate transaminase, serum glutamate-pyruvate transaminase, alkaline phosphatase, albumin, creatinine, Model for End-Stage Liver Disease (MELD) score, presence of liver comorbidity and presence of CLS were identified as potential prognostic parameters for ALF or death. In multivariate analysis, the MELD score remained the only predictor of ALF with an adjusted odds ratio (aOR) of 1.3 [95% confidence interval (CI): 1.1-1.5; P = < 0.001]. An initial MELD score ≥ 15 was associated with ALF from DISH with an area under the receiver operating characteristic (AUROC) of 0.91, 88.2% sensitivity and 87.3% specificity. Regarding mortality prediction, the deterioration of liver function to ALF was the most significant factor related to death in DISH patients (aOR 108.5, 95%CI: 5.5-2145.4, P = 0.002). Other independent factors associated with death included baseline INR (aOR 10.4, 95%CI: 2.6-40.5, P = 0.001). An INR ≥ 1.5 predicted death from DISH with an AUROC of 0.83 (81.8% sensitivity and 86.8% specificity). CONCLUSION The MELD score is the best predictor of ALF in DISH patients, a complication from dengue that is associated with high mortality. The presence of ALF and the baseline INR level are independent markers of death in DISH patients.

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Section: Discussionsupporting

confidence: 92%

Acute liver failure and death predictors in patients with dengue-induced severe hepatitis

Teerasarntipan¹,

Chaiteerakij²,

Komolmit³

et al. 2020

WJG

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“…El uso actual de sistemas no biológicos como el de recirculación molecular adsorbente (MARS, por sus siglas en ingles), se ha practicado con seguridad en FHA de diferentes etiologías, mostrando beneficios sobre la ictericia, la inestabilidad hemodinámica, la hipertensión portal y endocraneana, y la encefalopatía hepática con reportes favorables en la FHA por dengue (18). Finalmente, el éxito con resolución del shock por dengue y la FHA gracias al trasplante hepático ha sido documentado en pocos casos por la baja disponibilidad en países donde el DENV es prevalente, pero pudiera ser una alternativa en centros que cuenten con programa de trasplante (19)(20).…”

Section: Discussionunclassified

Falla hepática aguda inducida por dengue

2023

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El dengue se consolida como problema de salud pública de importancia epidemiológica a nivel mundial; su curso es usualmente benigno, sin embargo; algunos pacientes desarrollan dengue grave con falla orgánica multisistemica; es de resaltar que la falla hepática aguda por dengue es poco frecuente pero potencialmente letal; en este contexto se presentará el siguiente caso clínico de hombre adulto que desarrolla falla hepática aguda por dengue

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“…with sALI or ALF) seems to be more prevalent in children [26] than in adults, it occurred in two patients in our series. In a retrospective study from Sri-Lanka, Kumarasena et al found a 39% risk of ALF in adults with SD and sAT activity above 1,000 UI/L (approximately 30 times the ULN) [27]. Consequently, an empiric strategy of early IV-NAC infusion, the recognised antidote against APAP hepatotoxicity [28], could be a therapeutic option for adults affected by dengue with such an increased sAT activity (even with no obvious features of APAP hepatotoxicity), especially when associated with at least two of the following three features: persistent nausea and vomiting, increased serum alkaline phosphatase, and serum bilirubin levels (27).…”

Section: Discussionmentioning

confidence: 99%

Two Liver Transplant Center’s Experience of Dengue-Associated Acute Liver Injury

2023

Ann Case Report

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Background: Acute liver failure is an uncommon, but often fatal, complication of dengue virus infection in adults. Aims: In this study, we aimed to evaluate the occurrence of a major adverse event to propose a management strategy. Methods: The files of seven patients hospitalised for dengue virus infection and severe acute liver injury from 1997 to 2013 were reviewed. Results: High levels of serum aminotransferases, bilirubin, and severe coagulopathy were observed. All patients had ingested acetaminophen during the last 3-5 days. Among them four had grade 0-I encephalopathy when N-acetylcysteine was administered intravenously. Two of them showed mediolobular liver necrosis, as observed in dengue virus-infected patients. One of these two patients developed severe metabolic acidosis and grade 4 encephalopathy despite continuous administration of N-acetylcysteine for 2 days but survived because of orthotopic liver transplantation. The two others had documented features of acetaminophen hepatotoxicity, with acute liver failure in one of them, but both survived. The remaining 3 patients developed acute liver failure with grade IV encephalopathy, hypotension, and renal failure. They died after protracted shock and medioor panlobular liver necrosis despite administration of delayed N-acetylcysteine. Conclusions: In cases of dengue-associated severe acute liver injury, acetaminophen administration is contraindicated, and N-acetylcysteine should be immediately administered with or without encephalopathy. Liver transplantation is the only therapeutic alternative for persistent acute liver failure, despite N-acetylcysteine.

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Predicting acute liver failure in dengue infection

Cited by 11 publications

References 3 publications

Acute liver failure and death predictors in patients with dengue-induced severe hepatitis

Acute liver failure and death predictors in patients with dengue-induced severe hepatitis

Falla hepática aguda inducida por dengue

Two Liver Transplant Center’s Experience of Dengue-Associated Acute Liver Injury

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