dengue infection, dengue hemorrhagic fever, atypical manifestations of dengue fever, hepatic failure in dengue
DOI: 10.5005/jp-journals-11009-0055 |
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Varma S, Consul M, Kukreja S, Saikia B, Uttam R, Das D, Bhatia N, Gupta S. Identification of Factors Predicting Mortality in Dengue Infection Associated Liver Failure. Ann Pediatr Gastroenterol Hepatol 2020; 2 (2):26-29.
Objectives: To identify factors predicting mortality in acute liver failure due to Dengue infection
Methods: Retrospective analysis was done to identify factors predicting mortality among children having acute liver failure (ALF) due to Dengue infection. admitted Children in Max Hospital PICU's between May 2017 and May 2019 ALF was diagnosed by PALF criteria; Dengue infection was diagnosed if NS-1 Antigen and/or IgM Dengue antibody were positive. Other causes of ALF were ruled out and all received standard of care treatment for ALF. The highest value of ammonia, urea, creatinine, AST, ALT, bilirubin, PT and apTT during the illness and lowest value of haemoglobin, leucocyte count, platelet, albumin, during the course of the illness were recorded. For continuous variables, mean was calculated and student T test was used to compare. Binary logistic regression was used and AUROC was calculated to determine cut off values and compare the utility of various parameters for the same.
Results: 15 children (8 boys) with mean age of 106 months were included. 8 of 15 had poor outcome (53% mortality). There was significant difference in ammonia, AST, ALT, aPTT levels between the survivors and non-survivors. Cut off values predicting mortality with sensitivity of 88% and specificity of 86% were increase of AST, ALT aPTT by 1750, 1011 IU/L and 53 seconds respectively; on a daily basis. Kings college criteria in poor outcome had sensitivity of 100% but poor specificity of 55.6%.
Conclusion: Rate of increase of AST, ALT, aPTT with appropriate cut off values can predict the outcome of Dengue induced ALF better than Kings College criteria.
Liver abscess is rare in newborns and fewer than 100 cases have been reported in the literature. In general, they are common in preterm infants with certain risk factors like umbilical vein catheterization, immunodeficiency, sepsis and so on. A possibility of hepatic abscess needs to be considered in a neonate presenting with sepsis and tender hepatomegaly. Majority of liver abscesses respond to intravenous antibiotics and does not need needle aspiration or surgical exploration. Here we report a case of the multiple liver abscess in a term baby secondary to sepsis.