Spectrum, Manifestations and Outcomes of Dengue Infection in Individuals with and without Liver Disease

Background and Aims: Dengue infection is a major health burden, which can result in mild self-limited febrile illness to highly fatal hemorrhagic disease. There is paucity of literature describing the manifestations of dengue in patients with underlying liver disease. We studied and compared the manifestations of this tropical infection in patients with and without liver disease. Methods: Patients with serologically-confirmed dengue infection were included in this retrospective study, obtained for over a period of 1 year. Demographic and laboratory variables were compared for the individuals with no underlying liver disease (Group A, n = 71), chronic hepatitis (Group B, n = 12), and cirrhosis (Group C, n = 12). Results: Males predominated the study population (61%), with a higher mean age in the cirrhotic group. The most common clinical manifestation was classical dengue fever, seen in 89 individuals. Two presented as dengue hemorrhagic fever (1 each in Group A and Group B), 1 presented as acute liver failure, and 3 as acute-on-chronic liver failure. Hemoconcentration was less evident in Group C as compared to Group A and Group B (p < 0.001). Patients in Group C had significantly prolonged International Normalized Ratio (INR) and enhanced thrombocytopenia compared to patients in Group A and Group B. Patients in Group C also required prolonged hospital stay (Group A: 4.83 ± 2.88, Group B: 7.33 ± 2.3, Group C: 13 ± 5 days; p < 0.001). Three patients expired in Group C compared to the 1 in Group A and none in Group B (p = 0.01). On univariate analysis, hemoglobin, albumin, INR, and bilirubin predicted development of liver failure. On multivariate analysis, INR and bilirubin predicted development of liver failure. Conclusions: Dengue infection can have varied manifestations, ranging from simple fever to acute-on-chronic liver failure and acute liver failure. Cirrhotic patients lack classical features of dengue and have relatively poor prognosis. Dengue should be suspected as a cause of liver failure in endemic areas, where no etiological cause is discernible.