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      A prospective 3 year study of clinical spectrum and outcome of dengue fever in ICU from a tertiary care hospital in North India

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          Abstract

          Background and Aims:

          The incidence of specific complications and adverse outcomes in dengue patients needing admission to intensive care units (ICU) may be quite variable in different regions of India presumably because of different strains of dengue virus or due to re infection.

          Methods:

          Patients admitted with acute febrile illness (AFI) with either positive IgM antibody or NS1 antigen for dengue were enrolled. Data were collected for 3 years (2015-2017). A total of 313 patients with acute febrile illness were admitted in the study period (2252 total ICU admissions). A total of 137 (43.76%) cases were serologically proven as dengue fever.

          Results:

          Median age (IQR) of study population was 36.0 (26.0–52.0) years. Liver (65.7%) was the main organ involved followed by acute kidney Injury (AKI) (18.6%). Dengue Shock Syndrome (DSS) was found in 18.6% of cases. Fifty-two patients died and the crude mortality was 38.0%. On multivariate analysis APACHE Score <10, thrombocytopenia, hepatic dysfunction, AKI and dengue shock syndrome (DSS) were associated with the risk of mortality.

          Conclusion:

          This study in ICU patients showed high mortality in relatively younger patients. Liver (in the form of raised Bilirubin) was the most common organ dysfunction. The need to recognise early warning signs for ICU admission is highlighted.

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          Liver Involvement Associated with Dengue Infection in Adults in Vietnam

          Dinh The Trung, Le Thi Thu Thao, Tran Hien … (2010)
          Globally, the number of adults hospitalized with dengue has increased markedly in recent years. It has been suggested that hepatic dysfunction is more significant in this group than among children. We describe the spectrum and evolution of disease manifestations among 644 adults with dengue who were prospectively recruited on admission to a major infectious disease hospital in southern Vietnam and compare them with a group of patients with similar illnesses not caused by dengue. Transaminase levels increased in virtually all dengue patients and correlated with other markers of disease severity. However, peak enzyme values usually occurred later than other complications. Clinically severe liver involvement was infrequent and idiosyncratic, but usually resulted in severe bleeding. Chronic co-infection with hepatitis B was associated with modestly but significantly increased levels of alanine aminotransferase, but did not otherwise impact the clinical picture.
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            Patterns and causes of liver involvement in acute dengue infection

            Samitha Fernando, Ananda Wijewickrama, Laksiri Gomes … (2016)
            Background Liver involvement in acute dengue infection is frequently observed and sometimes leads to acute liver failure, with fatal outcomes. Many factors are thought to contribute to liver dysfunction, including hypoxic injury due to decreased perfusion, direct damage by the virus and immune mediated injury. In this study, we sought to identify the pattern in the change in liver enzymes throughout the illness and its association with the degree of viraemia, onset and extent of plasma leakage and inflammatory mediators. Methods Serial daily blood samples were obtained from 55 adult patients with acute dengue from the time of admission to discharge and the liver function tests, viral loads and cytokines were assessed. The onset and extent of fluid leakage was measured by daily ultrasound examinations and all clinical and laboratory features were serially recorded. Results Aspartate transaminase (AST), alanine transaminase (ALT) and gamma glutamyl transferase (GGT) levels were elevated in patients with dengue infection throughout the illness. The highest AST levels were seen on day 6 of illness and both AST and GGT levels were significantly higher in patients with severe dengue (SD), when compared to those with non-severe dengue (NSD) on day 5 and 6 of illness. Three patients with SD had AST and ALT values of >1000/IU in the absence of any fluid leakage or a rise in the haematocrit (≥20 %). The peak of the AST levels and the lowest serum albumin levels were seen 24 h before the maximum fluid leakage and 24 h after the peak in viraemia. Both serum IL-10 and IL-17 levels were elevated during early illness and were significantly higher in those with SD when compared to NSD. Conclusion Dengue associated liver injury appears to peak around day 6 and 7. Therefore, liver function tests done at earlier dates might not reflect the extent of liver involvement in acute infection. Since severe liver involvement can occur in the absence of fluid leakage, after the peak viraemia, and since it is associated with high IL-17 and IL-10 levels, possible immune mechanisms leading to hepatic damage should be investigated. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1656-2) contains supplementary material, which is available to authorized users.
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              Is Diabetes a Risk Factor for a Severe Clinical Presentation of Dengue? - Review and Meta-analysis

              Nan Htun, Peter Odermatt, Ikenna Eze … (2015)
              Background The mean age of acute dengue has undergone a shift towards older ages. This fact points towards the relevance of assessing the influence of age-related comorbidities, such as diabetes, on the clinical presentation of dengue episodes. Identification of factors associated with a severe presentation is of high relevance, because timely treatment is the most important intervention to avert complications and death. This review summarizes and evaluates the published evidence on the association between diabetes and the risk of a severe clinical presentation of dengue. Methodology/Findings A systematic literature review was conducted using the MEDLINE database to access any relevant association between dengue and diabetes. Five case-control studies (4 hospital-based, 1 population-based) compared the prevalence of diabetes (self-reported or abstracted from medical records) of persons with dengue (acute or past; controls) and patients with severe clinical manifestations. All except one study were conducted before 2009 and all studies collected information towards WHO 1997 classification system. The reported odds ratios were formally summarized by random-effects meta-analyses. A diagnosis of diabetes was associated with an increased risk for a severe clinical presentation of dengue (OR 1.75; 95% CI: 1.08–2.84, p = 0.022). Conclusions/Significance Large prospective studies that systematically and objectively obtain relevant signs and symptoms of dengue fever episodes as well as of hyperglycemia in the past, and at the time of dengue diagnosis, are needed to properly address the effect of diabetes on the clinical presentation of an acute dengue fever episode. The currently available epidemiological evidence is very limited and only suggestive. The increasing global prevalence of both dengue and diabetes justifies further studies. At this point, confirmation of dengue infection as early as possible in diabetes patients with fever if living in dengue endemic regions seems justified. The presence of this co-morbidity may warrant closer observation for glycemic control and adapted fluid management to diminish the risk for a severe clinical presentation of dengue.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Anaesth
                Journal ID (iso-abbrev): Indian J Anaesth
                Journal ID (publisher-id): IJA
                Title: Indian Journal of Anaesthesia
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 0019-5049
                ISSN (Electronic): 0976-2817
                Publication date (Print): March 2020
                Publication date (Electronic): 11 March 2020
                Volume: 64
                Issue: 3
                Pages: 181-186
                Affiliations
                [1]Department of Critical Care and Emergency Medicine, Sir Gangaram Hospital, New Delhi, India
                Author notes
                Address for correspondence: Dr. Prakash S Shastri, Department of Critical Care and Emergency Medicine, Sir Gangaram Hospital, New Delhi, India. E-mail: prakashshastri@ 123456live.in
                Article
                Publisher ID: IJA-64-181
                DOI: 10.4103/ija.IJA_865_19
                PMC ID: 7179772
                SO-VID: 83312017-1d36-43b3-9453-c5bcbd9ac408
                Copyright © Copyright: © 2020 Indian Journal of Anaesthesia
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 22 December 2019
                Date revision received : 25 January 2020
                Date accepted : 12 February 2020
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: acute physiology and chronic health evaluation,dengue fever,igm,intensive care unit,ns1,shock,sequential organ failure assessment
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: acute physiology and chronic health evaluation, dengue fever, igm, intensive care unit, ns1, shock, sequential organ failure assessment

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