The magnitude of hepatic enzyme rise and it’s correlation with the severity of Dengue Hemorrhagic Fever Muhammad Abdur Rahim 1, Khwaja Nazim Uddin 2, AKM.

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The magnitude of hepatic enzyme rise and it’s correlation with the severity of Dengue Hemorrhagic Fever Muhammad Abdur Rahim 1, Khwaja Nazim Uddin 2, AKM Musa 3 , Md. Delwar Hossain 4, AKM Shaheen Ahmed 4, Jamal Uddin Ahmed 1, Tabassum Samad 5, RSC Sarker 5 1. Registrar, Internal Medicine, BIRDEM 2. Professor & Head, Internal Medicine, BIRDEM 3. Associate Professor, Internal Medicine, BIRDEM 4. Assistant Professor, Internal Medicine, BIRDEM 5. Senior Medical Officer, Internal Medicine, BIRDEM BIRDEM – Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine & Metabolic Disorders

Aims & objectives To see the incidence of hepatic involvement in dengue syndromes. To see the severity of hepatitis in dengue syndromes. To see any correlation between the severity of hepatitis with the severity of dengue hemorrhagic fever. To see the outcome of hepatitis in dengue syndromes.

Inclusion criteria Hospitalized adult patients presented with fever of less than 7 days duration. Clinical diagnosis of dengue fever. Serologically positive for dengue antibody (IgM ± IgG)

Exclusion criteria Fever for more than 7 days duration. Patients having convincing evidence of fever for other causes. Serologically negative for dengue antibody (IgM)

Methodology Study design: Cross-sectional, observational study Place of study: Department of Internal Medicine of BIRDEM Hospital , Dhaka, Bangladesh (A WHO collaborative 600 bedded tertiary care hospital for diabetic patients) Time of Study: July – December 2010 Study population: 50 serologically positive dengue fever patients

Results Total patients: 50 (64% male, 36% female) Diabetic: 17 (34%), Non-diabetic: 33 (66%) Mean age: 44.2 (21-54 years)

Hepatic enzymes were raised in 94% cases. Contd…. Hepatic enzymes were raised in 94% cases. AST level > ALT level in 92% cases. Mean serum bilirubin level:1.82 mg/dl. Mean serum alkaline phosphatase level: 125 U/L. Hepatic enzymes became normal within 3 weeks in 92% cases. No death occurred.

Distribution of patients according to severity of dengue syndromes 23 20 6 1

Mean lowest total count of WBC according to severity of dengue syndromes 4400 3760 3720 3680

Mean lowest platelet count according to severity of dengue syndromes 105000 48000 42000 22000

Mean AST & ALT level according to severity of dengue syndromes 298.0 232.0 212.6 198.7 97.3 86.2 61.7 54.9

Mean serum albumin level according to severity of dengue syndromes 36.4 34.5 30.8 26.2

Evidence of serositis according to severity of dengue syndromes 20% 50% 10% 33% 100% 0%

Mean hospital stay according to severity of dengue syndromes 10 6 6 4

Conclusion Hepatic involvement is common in dengue syndromes. Transaminase level correlates with the severity of the disease. In most patients hepatic function returns to normal after recovery.