Fariz Safhan, Mohamad Nor
(2008)
The study on liver function derangements in association with
severity and bleeding outcome in
dengue fever.
Masters thesis, Universiti Sains Malaysia.
Abstract
Dengue fever is an endemic infective disease which has seen a significant re-emergence
in Malaysia. Liver function derangements have been desctibed in dengue infection but its
association with bleeding occurrence has not been consistently shown in previous studies.
Objectives
The main objective was to study the association between liver function derangements and
the severity of dengue virus infection and bleeding outcomes.
Methodology
This is a cross-sectional study involving 144 patients with dengue virus infection (World
Health Organisation criteria) recruited from October 2005 until March 2006 in Hospital
Tengku Ampuan Afzan, Kuantan. Severity of dengue infection was classified into
uncomplicated dengue fever (DF) and dengue haemmThagic fever (DHF) with or without
Dengue Shock Syndrome (DSS). The bleeding outcomes were grouped into "no
bleeding", "petechiae", "minor bleeding" and "major bleeding". The association between
liver derangement and DHF was analysed using independent t-test and multiple logistic
regression analysis. The association between liver derangement and bleeding outcome
was analysed using Kruskal-Wallis and Mann-Whitney tests.
XII
Results
The mean patient's age was 31 ± 12 years old. There were 85 (59.7%) patients with
DHF. There were 31 (21.5%) patients who had no bleeding, 39 (27.1 %) patients had
petechiae, 53 (36.8%) patients had minor bleeding and 21 (14.6%) patients had major
bleeding. The mean AST level in DHF was 253.5 ± 205.5 IU/L (p<O.OOI), mean ALT
level in DHF was 171.1 ± 185.2 IU/L (p < 0.001), mean albumin level in DHF was 32.0
± 5.7 IU/L (p < 0.001), mean ALP level in DHF was 97.6 ± 48.9 J.tmol/L (p = 0.027) and
mean direct bilimbin level in DHF was 6.2 + 5.4 (p < 0.00 I). Multiple logistic regression
analysis showed that AST (OR 1.025, p < 0.001, 95% C.l. 1.014- 1.036), as well as
abdominal pain and plasma leakage were significantly associated with DHF. Bleeding
outcome was associated with the derangement of AST, AL T, albumin (p<O.OO I) and
direct bilimbin (p = 0.038) but not with ALP (p=0.585) and INR (p=0.593).
Conclusion
The study showed that a significant association existed between liver function
derangements, predominantly AST with DHF and bleeding outcome. AST can be a
useful surrogate marker to predict disease severity and bleeding outcome in dengue
infection.
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