Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Mar 25, 2024; 13(1): 91457
Published online Mar 25, 2024. doi: 10.5501/wjv.v13.i1.91457
Dengue induced acute liver failure: A meta summary of case reports
Deven Juneja, Ravi Jain, Prashant Nasa
Deven Juneja, Department of Critical Care Medicine, Max Super Speciality Hospital, New Delhi 110017, India
Ravi Jain, Department of Critical Care Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur 302022, Rajasthan, India
Prashant Nasa, Department of Critical Care Medicine, NMC Specialty Hospital, Dubai 7832, United Arab Emirates
Author contributions: Nasa P acquisition of data, analysis and interpretation of data, drafting the article, final approval; Juneja D acquisition of data, analysis and interpretation of data, drafting the article, final approval; Jain R interpretation of data, revising the article, final approval.
Conflict-of-interest statement: All authors declare no conflict-of-interest related to this work.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Prashant Nasa, MD, Chief Doctor, Department of Critical Care Medicine, NMC Specialty Hospital, Al Nahda 2, Amman Street, Dubai 7832, United Arab Emirates. dr.prashantnasa@gmail.com
Received: December 28, 2023
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
Abstract
BACKGROUND

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.

AIM

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.

METHODS

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.

RESULTS

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%).

CONCLUSION

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.

Keywords: Dengue fever; Acute liver failure; Dengue induced hepatitis; Hepatic failure; Fulminant hepatitis; Severe dengue

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.