Published online Mar 25, 2024. doi: 10.5501/wjv.v13.i1.91457
Peer-review started: December 28, 2023
First decision: January 16, 2024
Revised: January 19, 2024
Accepted: February 20, 2024
Article in press: February 20, 2024
Published online: March 25, 2024
Processing time: 73 Days and 19.7 Hours
Dengue fever is the most common cause of viral hemorrhagic fever, with more than 400 million cases being reported annually, worldwide. Even though hepatic involvement is common, acute liver failure (ALF) is a rare complication of dengue fever.
To analyze the demographic profile, symptomology, hospital course and outcomes of patients presenting with ALF secondary to dengue infection by reviewing the published case reports.
A systematic search was performed from multiple databases including PubMed, Reference Citation Analysis, Science Direct, and Google Scholar. The search terms used were "dengue" OR "severe dengue" OR "dengue shock syndrome" OR "dengue haemorrhagic syndrome" OR "dengue fever" AND "acute liver failure" OR "hepatic failure" OR "liver injury". The inclusion criteria were: (1) Case reports or case series with individual patient details; (2) Reported acute liver failure secondary to dengue infection; and (3) Published in English language and on adult humans. The data were extracted for patient demographics, clinical symptomatology, clinical interventions, hospital and intensive care unit course, need for organ support and clinical outcomes.
Data from 19 case reports fulfilling the predefined inclusion criteria were included. The median age of patients was 38 years (inter quartile range: Q3-Q1 26.5 years) with a female preponderance (52.6%). The median days from diagnosis of dengue to development of ALF was 4.5 d. The increase in aspartate aminotransferase was higher than that in alanine aminotransferase (median 4625 U/L vs 3100 U/L). All the patients had one or more organ failure, with neurological failure present in 73.7% cases. 42.1% patients required vasopressor support and hepatic encephalopathy was the most reported complication in 13 (68.4%) cases. Most of the patients were managed conservatively and 2 patients were taken up for liver transplantation. Only 1 death was reported (5.3%).
Dengue infection may rarely lead to ALF. These patients may frequently require intensive care and organ support. Even though most of these patients may improve with supportive care, liver transplantation may be a therapeutic option in refractory cases.
Core Tip: Dengue infection frequently affects liver function but, in most cases, it exhibits transient and mild increase of transaminases. Rarely, it may lead to severe liver injury and development of acute liver failure (ALF). As there is no specific therapy, most of these patients are managed conservatively and provided with organ support. N-acetyl cysteine is increasingly been used in the management of non-paracetamol induced ALF. However, its utility in ALF secondary to dengue is still limited to small case series and case reports. Even liver transplantation has been rarely attempted in these patients because of high incidence of underlying multi-organ failure and increased risk of bleeding. However, clinical outcomes in these patients may be improved with early recognition and timely supportive care.