Assessment of hepatic dysfunction in patients with dengue fever: A cross-sectional study
DOI:
https://doi.org/10.61529/idjp.v34i2.402Abstract
Background: Dengue fever, the most significant arthropod-borne illness, is transmitted by Aedes mosquitoes and caused by four DENV serotypes, leading to symptoms ranging from mild fever to severe forms like dengue hemorrhagic fever and dengue shock syndrome. This study aimed to assess hepatic dysfunction in patients with dengue fever and identify clinical and laboratory predictors of liver-related complications.
Material and Methods: This cross-sectional study was carried out over six months (June to December 2024) at the Department of Medicine, Bacha Khan Medical College and Mardan Medical Complex. Dengue-positive patients aged 17 years and above (confirmed via NS-1, IgG, or IgM) were enrolled using non-probability consecutive sampling. Patients under 17 or with malaria co-infection or chronic liver disease were excluded. Clinical evaluation included complete blood count, liver function tests, and abdominal ultrasound. Associations between liver complications and variables such as age, platelet count, bilirubin levels, and hepatomegaly were analyzed using SPSS version 29.
Results: Most patients (58.8%) were male, with a mean age of 34.2 ± 9.3 years. Hepatomegaly was present in 31.8%, while elevated ALT and bilirubin were noted in 38.3% and 45.9% respectively. ALT levels were significantly higher in patients with hepatomegaly (p=0.004).
Conclusion: The study underscores the need to monitor liver function in dengue patients, especially those with hepatomegaly, high bilirubin, and low platelets, as these indicate hepatic dysfunction and disease severity. Early detection and management may enhance outcomes.
Keywords: Dengue, Hepatic dysfunction, Liver enzymes, Hepatomegaly, Platelet count, Total bilirubin, ALT, Pakistan
References
Fox T, Geppert J, Dinnes J, Scandrett K, Bigio J, Sulis G, et al. Antibody tests for identification of current and past infection with SARS-CoV-2. Cochrane Database Syst Rev. 2022; 11(11): DOI: https://doi.org/10.1002/14651858.cd013652.pub2
Bryant A, Hiu S, Kunonga PT, Gajjar K, Craig D, Vale L, et al. Impact of residual disease as a prognostic factor for survival in women with advanced epithelial ovarian cancer after primary surgery. Cochrane Database of Systematic Reviews. 2022; 9(9): CD015048. DOI: https://doi.org/10.1002/14651858.cd015048.pub2
Swamy AM, Mahesh PY, Rajashekar ST. Liver function in dengue and its correlation with disease severity: a retrospective cross-sectional observational study in a tertiary care center in Coastal India. Pan Afr Med J. 2021; 40(1). 261. DOI: https://doi.org/10.11604/pamj.2021.40.261.29795
Kumari S, Tiwari AK, Sandilya GK, Achari V. A Study on the correlation between disease severity and hepatic dysfunction in dengue viral infection. Int J Life Sci Biotechnol, Pharma Res. 2024; 13 (10): 958-63. Available from:https://www.ijlbpr.com/uploadfiles/166vol13issue10pp958-963.20250416051440.pdf
World Health Organization (13 October 2022). Disease Outbreak News; Dengue –Pakistan. Available from: https://www.who.int/emergencies/disease-outbreak- news/item/2022-DON414
Sadiq S, Mobeen A, Ashraf N, Hashmi F, Munir S, Ahmad A. Clinical profile and liver functions in dengue fever. JRMC. 2024; 28(4). DOI: https://doi.org/10.37939/jrmc.v28i4.2486
Wang Z, Huang F, Li S, Li X, Liu Y, Shao B, et al. [Establishment and validation of a sepsis 28-day mortality prediction model based on the lactate dehydrogenase-to-albumin ratio in patients with sepsis]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2024; 36(11): 1140–6. DOI: https://doi.org/10.3760/cma.j.cn121430-20231012-00865
Ahmed A, Alvi AH, Butt A, Nawaz AA, Hanif A. Assessment of dengue fever severity through liver function tests. J Coll Physicians Surg Pak. 2014; 24(9): 640-4. Available from: https://www.jcpsp.pk/archive/2014/Sep2014/08.pdf
Reddy KP, Mahesh M, Sudha VS, Saikiran M, Ernesto CM, Sarojini P, et al. Aminotransferases in relation to the severity of dengue: A systematic review. Cureus. 2023; 15(5): e39436. DOI: https://doi.org/10.7759/cureus.39436
Lee LK, Gan VC, Lee VJ, Tan AS, Leo YS, Lye DC. Clinical relevance and discriminatory value of elevated liver aminotransferase levels for dengue severity. PLoS Negl Trop Dis. 2012; 6(6): e1676. DOI: https://doi.org/10.1371/journal.pntd.0001676
Parkash O, Almas A, Jafri SW, Hamid S, Akhtar J, Alishah H. Severity of acute hepatitis and its outcome in patients with dengue fever in a tertiary care hospital Karachi, Pakistan (South Asia). BMC Gastroenterol. 2010; 10: 43. DOI: https://doi.org/10.1186/1471-230x-10-43
Trung DT, Thao LTT, Hien TT, Hung NT, Vinh NN, Hien PTD, et al. Liver involvement associated with dengue infection in adults in Vietnam. Am J Trop Med Hyg. 2010; 83(4): 774–80. DOI: https://doi.org/10.4269/ajtmh.2010.10-0090
Khan, ZU, Batool R. Khan RTA, Shaikh, M T A, Haq SUM, Begum, L. Hepatic dysfunction in dengue fever: prevalence, patterns, and clinical correlation. Indus J Biosci Res. 2025; 3(3): 588–93. DOI: https://doi.org/10.70749/ijbr.v3i3.947
Souza LJ de, Alves JG, Nogueira RMR, Gicovate Neto C, Bastos DA, Siqueira EW da S, et al. Aminotransferase changes and acute hepatitis in patients with dengue fever: Analysis of 1,585 cases. Braz J Infect Dis. 2004; 8(2):156–63.
DOI: https://doi.org/10.1590/s1413-86702004000200006
Verma A, Chouhan P, Singh R, Meena R. Hepatic dysfunction in dengue: A tertiary care hospital experience. Asian J Pharm Clin Res. 2022; 15(4): 95-6. DOI: http://dx.doi.org/10.5455/IJMRCR.172-1634119739
Kumar DR, Sali DN. Dr. John Basha Shaik, 2024. Study on liver enzymes as an early predictor of complicated dengue fever in a tertiary care hospital. Res J Med Sci. 2024; 18: 709-12. Available from: https://makhillpublications.co/files/published-files/mak-rjms/2024/12-709-712.pdf
Ray G, Kumar V, Kapoor AK, Dutta AK, Batra S. Status of antioxidants and other biochemical abnormalities in children with dengue fever. J Trop Pediatr. 1999; 45(1):4–7. DOI: https://doi.org/10.1093/tropej/45.1.4
Saha AK, Maitra S, Hazra SC. Spectrum of hepatic dysfunction in 2012 dengue epidemic in Kolkata, West Bengal. Indian J Gastroenterol. 2013; 32(6): 400–3. DOI: https://doi.org/10.1007/s12664-013-0382-6
Seneviratne SL, Malavige GN, de Silva HJ. Pathogenesis of liver involvement during dengue viral infections. Trans R Soc Trop Med Hyg. 2006; 100(7): 608–14. DOI: https://doi.org/10.1016/j.trstmh.2005.10.007
Jamil M, Ahmed T, Ali MM, Javed HJ, Waheed A, Ahmed A, Jamil MI. Assessment of abnormal liver function tests in dengue fever: Implications for disease severity and outcome. Indus J Biosci Res. 2025; 3(4): 144-9.
DOI: https://doi.org/10.70749/ijbr.v3i4.779
Ahmad WA, Jamil SH, Hussain RI, Umar NA, Sheikh F. A clinical study to see the correlation between the degree of impaired liver function tests (LFT’S) and the complications in dengue fever. Pak J Med Health Sci. 2012; 2(6): 472-75. Available from: https://pjmhsonline. com/2012/apr_june/pdf/472
Verma AK, Modugula S. Swetha N, Praharaj D, Anand AC. Spectrum of liver dysfunction and the indicators of severe disease in dengue patients. Int J Trop Med. 2023; 18: 64-8. Available from: https://makhillpublications. co/files/published-files/mak-ijtm/2023/3-64-68.pdf
Edupuganti R, Bhaskarrao U, Shivram G. Clinical study of hepatic dysfunction in dengue patients in a tertiary care center. J Assoc Physicians India. 2022; 70(4): 11-2. PMID: 35443475.
Ganeshkumar P, Murhekar MV, Poornima V, Saravanakumar V, Sukumaran K, Anandaselvasankar A, et al. Dengue infection in India: A systematic review and meta-analysis. PLoS Negl Trop Dis. 2018; 12(7): e0006618.
DOI: https://doi.org/10.1371/journal.pntd.0006618
Kakkar M. Dengue fever is massively under-reported in India, hampering our response. BMJ. 2012; 345: e8574.
DOI: https://doi.org/10.1136/bmj.e8574
Soni A, Patel PM, Malhi NS, Avasthi GL. Spectrum of liver dysfunction in patients with dengue infection and the markers of severe disease: Study from a tertiary care centre in Punjab. J Liver Res Disord Ther. 2017; 3(4): 95-8. DOI: http://dx.doi.org/10.15406/jlrdt.2017.03.00063
Khan ZU, Batool R, Khan RT, Shaikh MT, Haq MS, Begum L. Hepatic Dysfunction in Dengue Fever: Prevalence, Patterns, and Clinical Correlation. Indus J Bioscience Res. 2025; 3(3): 588-93. https://doi.org/10.70749/ijbr.v3i3.947
Chhina RS, Goyal O, Chhina DK, Goyal P, Kumar R. Liver function tests in patients with dengue viral infection. WHO Regional Office for South-East Asia. 2008; 32: 110-7. DOI: https://iris.who.int/bitstream/handle/10665/170 475/ db2008v32p110.pdf?sequence=1&isAllowed=y
Tsheten T, Clements AC, Gray DJ, Adhikary RK, Furuya-Kanamori L, Wangdi K. Clinical predictors of severe dengue: a systematic review and meta-analysis. Infect Dis Poverty. 2021; 10:1-0. DOI https://doi.org/10.1186/s40249-021-00908-2
Tejo AM, Hamasaki DT, Menezes LM, Ho YL. Severe dengue in the intensive care unit. J Intensive Med. 2024; 4(01): 16-33. DOI: https://doi.org/10.1016/j.jointm.2023.07.007
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Editor Office
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
