1. 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

2. 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.

3. 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)

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

5. 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

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

7. 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.

8. Distribution of patients according to severity of dengue syndromes23 20 6 1

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

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

11. 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

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

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

14. Mean hospital stay according to severity of dengue syndromes10 6 6 4

15. 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.