Dengue induced acute liver failure: A meta summary of case reports

Table 1 Details of published case reports

Number	Ref.	Country	Age	Sex	Comorbidities	MELD score	Complications	Organ support	Outcome
1	Subramanian et al[28], 2005	India	35	M	None	17	None	None	Alive
2	Vinodh et al[29], 2005	India	19	M	None	30	Shock	Vasopressors	Alive
3	Penafiel et al[25], 2006	Singapore	69	M	None	NA	GI bleed, HE	RRT, IMV, MARS	Alive
4	Ling et al[22], 2007	Singapore	55	M	None	NA	None	None	Alive
5	Gasperino et al[19], 2007	United States	69	F	CAD	30	HE	Vasopressors, RRT, IMV	Alive
6	Osorio et al[23], 2008	Canada	31	F	None	NA	MODS	NA	Dead
7	Sedhain et al[27], 2011	Nepal	20	F	None	31	ARF	None	Alive
8	Agarwal et al[13], 2011	India	33	M	None	25	HE, seizures	None	Alive
9	Jhamb et al[21], 2011	India	19	M	None	27	HE, shock, GI bleed	IMV	Alive
10	Abeysekera et al[12], 2012	Sri Lanka	52	F	Hypertension	NA	HE	None	Alive
11	Arora et al[14], 2015	India	22	M	None	10	Minor bleeding, HE	None	Alive
12	Dalugama et al[16], 2017	Sri Lanka	53	M	None	16	None	None	Alive
13	Dalugama et al[17], 2018	Sri Lanka	43	F	Diabetes, dyslipidaemia	NA	Shock, HE, AKI, GI bleed	RRT	Alive
14	Samarasekara et al[26], 2018	Sri Lanka	38	F	None	26	DVT, AKI	None	Alive
15	Galante et al[18], 2019	Canada	49	F	None	NA	Shock, AKI, HE	Vasopressors, RRT, IMV	Alive
16	Paul et al[24], 2020	India	50	M	Alcoholic liver disease	29	HE	None	Alive
17	Lewis et al[30], 2020	United States	23	F	None	NA	HE	None	Alive
18	Chikkala et al[15], 2021	India	29	F	None	38	HE	Vasopressors, RRT, IMV	Alive
19	Gunasekera et al[20], 2022	Sri Lanka	54	F	Hypertension, diabetes	36	Bleeding, HE, AKI	Vasopressors, RRT, IMV	Alive

AKI: Acute kidney injury; CAD: Coronary artery disease; DVT: Deep venous thrombosis; F: Female; GI: Gastrointestinal; HE: Hepatic encephalopathy; IMV: Invasive mechanical ventilation; M: Male; MODS: Multi organ dysfunction syndrome; NA: Not available; RRT: Renal replacement therapy.

Table 2 Baseline patient parameters

Parameter of interest	Frequency (%)
Age (yr), median	38 (IQR 26.5)
Sex	Females 10 (52.6%)
Country of origin
India	7 (36.8)
Sri Lanka	5 (26.3)
Canada	2 (10.5)
Singapore	2 (10.5)
United States of America	2 (10.5)
Nepal	1 (5.3)
Diagnostic methodology
Only serology (IgM)	14 (73.7)
Only antigen (NS1 Ag)	3 (15.8)
Both antigen (NS1 Ag) and serology (IgM)	2 (10.5)
Capillary leak syndrome	11 (57.9)
Dengue shock syndrome	15 (78.9)
Diagnosis of dengue to ALF in days, median (IQR Q3-Q1)	4.5 (1)

ALF: Acute liver failure; IQR: Interquartile range; IgM: Immunoglobin M; Ag: Antigen.

Table 3 Baseline laboratory parameters and hospital course

Parameter of interest	Frequency (%)
Hematocrit, median	42.60 (IQR 15.15)
Total leucocyte count (per µL), median	5800 (IQR 5800)
Platelet count (per µL), median	25500 (IQR 28250)
AST (U/L), median	4625 (IQR 11902.5)
ALT (U/L), median	3100 (IQR 2607)
AST/ALT ratio, median	2.45 (IQR 1.75)
Alkaline phosphatase (IU/L), median	191 (IQR 117)
Total bilirubin (mg/dL), median	5.5 (IQR 5.63)
Direct bilirubin (mg/dL), median	2.55 (IQR 2.75)
INR, median	2.13 (IQR 1.79)
Albumin (g/L), median	2.85 (IQR 0.48)
Creatinine (mg/dL), median	1.63 (IQR 2.12)
MELD score, median	27.5 (IQR 5)
Days of ICU stay, median	6 (IQR 2)
Specific therapies
N-acetyl cysteine	6 (31.6)
Types of organ support
Vasopressors	8 (42.1)
Renal replacement therapy	6 (31.6)
Ventilation	6 (31.6)
MARS	1 (5.3)
Organ failure	14 (73.7)
Neurological	10 (52.6)
Cardiac	8 (42.1)
Renal	7 (36.8)
Respiratory
Complications
Hepatic encephalopathy	13 (68.4)
Bleedings	3 (15.8)
DVT	1 (5.3)
Liver transplantation	2 (10.5)
Death	1 (5.3)

AST: Aspartate aminotransferase; ALT: Alanine transaminase; MARS: Molecular adsorbent recirculating system; ICU: Intensive care unit; DVT: Deep venous thrombosis; MELD: Model for end-stage liver disease.