Study Of Dengue Fever With Outcome Analysis In Patients With Normal And Abnormal Liver Function Tests

DR RANGANI MUKESH NALINBHAI, Trivedi D A, Patel K, Patel R

DR RANGANI MUKESH NALINBHAI, Trivedi D A, Patel K, Patel R

Keywords: dengue fever, liver function, outcome; length of stay, mortality

Abstract

Background: Study of 100 cases of dengue fever with comparison of outcome in patients with abnormal liver function test v/s normal liver function test.
Methods: An observational and analytical study conducted in GMERS medical college and hospital sola Ahmadabad. 100 adult age 18 -75 years patients were included in time period of April, 2014 to April, 2015. Cases of Dengue fever were taken for study presenting with two or more symptoms of dengue fever and positive serology. Routine investigations, liver function tests and ultrasonography of abdomen were carried out. Measurement of outcome with regards to complication, mortality and Length of stay were studied.
Results: Out of 100 patients 60 were Classical DF, 31 DHF and 9 were of DSS. Fever was the most common and Nausea and vomiting was the next common complaint. Significant percentage of Epistaxis and Bleeding were observed in DHF (48.4%) group of patients. Average total bilirubin at presentation was markedly elevated in DSS (2.02 ±1.38) in comparison to DHF (1.28 ±1.02) and Classical DF (0.84 ±1.00) (P<0.05). Average SGPT at presentation was observed to be significantly higher in DSS group (351.38 ±402.75) followed by DHF (120.56 ±95.20) and Classical DF (95.40 ± 66.55) group. The difference was statistically significant (P<0.05). Average peak APTT observed to be higher in DSS (44.8± 8.2) group followed by DHF (42.2 ±13.0) and Classical DF (39.6 ±9.4). SGOT at presentation and the peak value of SGOT with bleeding episodes was observed to be statistically significant. The average length of hospital stay was 5 days. Correlation between average SGOT and average length of stay in the groups with Classical DF and DSS was statistically significant (P<0.05).
Conclusion: Altered liver function test in dengue infection has got effect in terms of length of stay and complications as compared to normal or mild alteration of liver function test. Therefore high SGOT and SGPT can be considered as a prognostic marker of outcome in dengue infection.

References

1. Shukla V, Chandra A, A study of hepatic dysfunction in Dengue, JAPI, july2013, vol61.1-3.
2. World Health Organization, Dengue- guidelines for diagnosis, treatment, prevention and control. New Edition, Geneva: World Health Organization Publishers; 2009. p. 4-6.
3. George R: LLCS. Clinical spectrum of dengue infection. Washington Cab International; 1997,3-5
4. de Souza LJ, Goncalves Carneiro H, Souto Filho JT, Ferreira de Souza T, Azevedo Cortes V, Neto CG, Bastos DA, da Silva Siqueira EW: Hepatitis in dengue shock syndrome. Braz J Infect Dis 2002, 6(6):322-7.
5. Kalayanarooj S, Vaughn DW, Nimmannitya S, Green S, Suntayakorn S, Kunentrasai N, Viramitrachai W, Ratanachu-eke S, Kiatpolpoj S, Innis BL, Rothman AL, Nisalak A, Ennis FA: Early clinical and laboratory indicators of acute dengue illness. J Infect Dis 1997, 176(2):313-21.
6. de Souza LJ, Nogueira RM, Soares LC, Soares CE, Ribas BF, Alves FP, Vieira FR, Pessanha FE: The impact of dengue on liver function as evaluated by aminotransferase levels. Braz J Infect Dis 2007, 11(4):407-10.
7. Patel LR , Sero prevalence of Dengue NS-1 Antigen in Tertiary care hospital, Ahmadabad , Indian Journal of Basic & Applied Medical Research; June 2013: 7, (2), P. 694-701.
8. Kishore J., Singh J., Dhole T.N., and Ayyagari A., Clinical and Serological Study of First Large Epidemic of Dengue in and around Lucknow, India, in 2003 Dengue Bulletin – Volume 30, 2006.
9. Chaturvedi UC., and Nagar R., Dengue and dengue Hemorrhagic fever: Indian perspective; J. Biosci. 2008,429–441.
10. Sharma S, Sharma SK, Mohan A, Wadhwa J, Dar L, Thulkar S, et al. Clinical profile of dengue Hemorrhagic fever in adults during 1996-outbreak in Delhi, India. Dengue Bull 1998;22:20- 27 WHO-SEARO).
11. Muhammad A., Khazindar AM., Lubbad EH., Barlas S, Alfi AY., Ukayli AS., Characteristics of Dengue Fever in a Large Public Hospital, Jeddah, Saudi Arabia. J Ayub Med Coll Abbottabad 2006;18(2).
12. Itha S., Kashyap R., Krishnani N, Vivek A. Saraswat, Choudhuri G, Aggarwal R. The National Medical Journal Of India Vol. 18, NO. 3, 2005.
13. Farid Uddin A., Chowdhury B., Mahmood J., Sharma JD, Hoque M., Zaman R., and ShameemHasan M.,Dengue and Dengue Hemorrhagic Fever in Children During the 2000 Outbreak in Chittagong, Bangladesh.Dengue Bulletin – Vol 25, 2001.
14. Uchadadia S, Ghodke B, Bhuta K,Kejriwal A, Ghanekar J. Degree of Impairment of Liver Function in Dengue Fever Correlates to the Severity of its Complications, MGM J Med Sci 2015;2(3):115119.
15. Parkash et al., Severity of acute hepatitis and its outcome in patients with dengue fever in a tertiary care hospital Karachi, Pakistan (South Asia) BMC Gastroenterology 2010, 10:43
16. Souza, L.J., Alves, J.G., Nogueira, R.M.R., Neto, C.G., Bastos, D.A., da Siva Siqueira, E.W., SoutoFilho, J.T.D., Cezario, T.A., Soares, C.E., Carneiro, R.C., 2004.
17. Khan, E., Kisat, M., Khan, N., Nasir, A., Ayub, S., &Hasan, R. (2010). Demographic and clinical features of dengue fever in Pakistan from 2003–2007: A retrospective cross-sectional study. PLoS One, 5, e12505.
18. Shah I., Dengue and liver disease. Scand J Infect Dis 2008, 40(11- 12):993-4.