Volume 95, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Acute liver failure is an atypical manifestation of dengue with a high mortality. We performed a retrospective cohort study at the Hospital for Tropical Diseases, Bangkok, Thailand. In total, 1,926 patients with serologically confirmed dengue were enrolled in the study from 2011 to 2015. Of these, six patients presented with acute liver failure, four died, and two survived. The incidence of dengue-associated acute liver failure was 0.31%. Dengue-associated acute liver failure was most common among young adults (median age, 29 years). The median duration from onset of fever to development of acute liver failure was 7.5 days. Patients with the severe stage of dengue had a higher risk of developing acute liver failure ( < 0.001). The baseline risk factors associated with the development of acute liver failure were an age of ≤ 40 years (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.1–2.0, < 0.05), a > 10% ratio of atypical lymphocytes (OR = 2.3, 95% CI = 1.8–3.0, < 0.001), and a platelet count of < 50,000 mm (OR = 2.8, 95% CI = 2.2–3.6, < 0.001). The incidence of acute liver failure in patients with dengue was quite low, but its impact on morbidity, mortality, and poor clinical outcomes was significant. In summary, this study indicates that various baseline risk factors are associated with acute liver failure in patients with dengue.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Malavige GN, Fernando S, Fernando DJ, Seneviratne SL, , 2004. Dengue viral infections. Postgrad Med J 80: 588601.[Crossref] [Google Scholar]
  2. Villar LA, Rojas DP, Besada-Lombana S, Sarti E, , 2015. Epidemiological trends of dengue disease in Colombia (2000–2011): a systematic review. PLoS Negl Trop Dis 9: e0003499.[Crossref] [Google Scholar]
  3. World Health Organization, 2009. Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control. Geneva, Switzerland: World Health Organization. [Google Scholar]
  4. Nimmagadda SS, Mahabala C, Boloor A, Raghuram PM, Nayak U, , 2014. Atypical manifestations of dengue fever (DF): where do we stand today. J Clin Diagn Res 8: 7173. [Google Scholar]
  5. Polson J, Lee WM, American Association for the Study of Liver Diseases, , 2005. AASLD position paper: the management of acute liver failure. Hepatology 41: 11791197.[Crossref] [Google Scholar]
  6. Lee WM, Larson AM, Stravitz RT, , 2011. AASLD Position Paper: The Management of Acute Liver Failure: Update 2011. Alexandria, VA: American Association for the Study of Liver Diseases. [Google Scholar]
  7. Trung DT, Thao Le TT, Hien TT, Hung NT, Vinh NN, Hien PT, Chinh NT, Simmons C, Wills B, , 2010. Liver involvement associated with dengue infection in adults in Vietnam. Am J Trop Med Hyg 83: 774780.[Crossref] [Google Scholar]
  8. Itha S, Kashyap R, Krishnani N, Saraswat VA, Choudhuri G, Aggarwal R, , 2005. Profile of liver involvement in dengue virus infection. Natl Med J India 18: 127. [Google Scholar]
  9. Gasperino J, Yunen J, Guh A, Tanaka KE, Kvetan V, Doyle H, , 2007. Fulminant liver failure secondary to haemorrhagic dengue in an international traveller. Liver Int 27: 11481151.[Crossref] [Google Scholar]
  10. Tan SS, Bujang MA, , 2013. The clinical features and outcomes of acute liver failure associated with dengue infection in adults: a case series. Braz J Infect Dis 17: 164169.[Crossref] [Google Scholar]
  11. Parkash O, Almas A, Jafri SM, Hamid S, Akhtar J, Alishah H, , 2010. Severity of acute hepatitis and its outcome in patients with dengue fever in a tertiary care hospital Karachi, Pakistan (south Asia). BMC Gastroenterol 10: 43.[Crossref] [Google Scholar]
  12. Squires RH, , 2008. Acute liver failure in children. Semin Liver Dis 28: 153166.[Crossref] [Google Scholar]
  13. Gotthardt D, Riediger C, Weiss KH, Encke J, Schemmer P, Schmidt J, Sauer P, , 2007. Fulminant hepatic failure: etiology and indications for liver transplantation. Nephrol Dial Transplant 22 (Suppl 8): viii5viii8. [Google Scholar]
  14. Gill RQ, Sterling RK, , 2001. Acute liver failure. J Clin Gastroenterol 33: 191198.[Crossref] [Google Scholar]
  15. Vinodh B, Bammigatti C, Kumar A, Mittal V, , 2005. Dengue fever with acute liver failure. J Postgrad Med 51: 322. [Google Scholar]
  16. Kuo CH, Tai DI, Chang-Chien CS, Lan CK, Chiou SS, Liaw YF, , 1992. Liver biochemical tests and dengue fever. Am J Trop Med Hyg 47: 265270. [Google Scholar]
  17. Nguyen TL, Nguyen TH, Tieu NT, , 1997. The impact of dengue haemorrhagic fever on liver function. Res Virol 148: 273277.[Crossref] [Google Scholar]
  18. American Gastroenterological Association, 2002. American Gastroenterological Association medical position statement: evaluation of liver chemistry tests. Gastroenterology 123: 13641366.[Crossref] [Google Scholar]
  19. Kim TY, Kim DJ, , 2013. Acute-on-chronic liver failure. Clin Mol Hepatol 19: 349359.[Crossref] [Google Scholar]
  20. Buchman AL, Iyer K, Fryer J, , 2006. Parenteral nutrition–associated liver disease and the role for isolated intestine and intestine/liver transplantation. Hepatology 43: 919.[Crossref] [Google Scholar]
  21. Yung CF, Lee KS, Thein TL, Tan LK, Gan VC, Wong JG, , 2015. Dengue serotype-specific differences in clinical manifestation, laboratory parameters and risk of severe disease in adults, Singapore. Am J Trop Med Hyg 92: 9991005.[Crossref] [Google Scholar]
  22. Sedhain A, Adhikari S, Regmi S, Chaudhari SK, Shah M, Shrestha B, , 2011. Fulminant hepatic failure due to dengue. Kathmandu Univ Med J 9: 7375. [Google Scholar]
  23. Treeprasertsuk S, Kittitrakul C, , 2015. Liver complications in adult dengue and current management. Southeast Asian J Trop Med Public Health 46 (Suppl 1): 99107. [Google Scholar]
  24. Senaratne T, Carr J, Noordeen F, , 2016. Elevation in liver enzymes is associated with increased IL-2 and predicts severe outcomes in clinically apparent dengue virus infection. Cytokine 83: 182188.[Crossref] [Google Scholar]
  25. Thomas SJ, Endy TP, , 2011. Vaccines for the prevention of dengue: development update. Hum Vaccin 7: 674684.[Crossref] [Google Scholar]
  26. Tang KF, Ooi EE, , 2012. Diagnosis of dengue: an update. Expert Rev Anti Infect Ther 10: 895907.[Crossref] [Google Scholar]
  27. Sinha G, , 2014. Sanofi's dengue vaccine first to complete phase 3. Nat Biotechnol 32: 605606.[Crossref] [Google Scholar]
  28. Hadinegoro SR, Arredondo-Garcia JL, Capeding MR, Deseda C, Chotpitayasunondh T, Dietze R, Muhammad Ismail HI, Reynales H, Limkittikul K, Rivera-Medina DM, Tran HN, Bouckenooghe A, Chansinghakul D, Cortes M, Fanouillere K, Forrat R, Frago C, Gailhardou S, Jackson N, Noriega F, Plennevaux E, Wartel TA, Zambrano B, Saville M, CYD-TDV Dengue Vaccine Working Group, , 2015. Efficacy and long-term safety of a dengue vaccine in regions of endemic disease. N Engl J Med 373: 11951206.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 10 May 2016
  • Accepted : 13 Sep 2016
  • Published online : 07 Dec 2016

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error