Validation of Serum Aminotransferases Levels to Define SevereDengue Fever in Children

다국어 초록 (Multilingual Abstract)

Purpose: We aimed to study the pattern of liver-injury in children with dengue fever (DF) and validate serum amino-transferase ≥1,000 IU/L as a marker of severe DF.Methods: Children admitted with DF were included. DF was defined by presence of clinical criteria and positive serological or antigen tests in absence of other etiology. DF severity was graded as dengue without or with warning signs and severe dengue. Liver-injury was defined as alanine aminotransferase (ALT) more than twice the upper limit of normal (boys, 30 IU/L; girls, 21 IU/L).Results: Of 372 children with DF, 144 (38.7%) had liver-injury. Risk of liver-injury and aminotransferase levels increased with DF severity (p＜0.001). Recommended ALT and aspartate aminotransferase (AST) cut-off at ≥1,000 IU/L had sensitivity 4.8% (5/105), specificity 99.3% (265/267) for detection of severe DF. In children with ALT and AST ＜1,000 IU/L (n=365), the area under receiver operating curves for prediction for severe DF, were 0.651 (95% confidence interval [CI], 0.588-0.714; p＜0.001) for ALT and 0.647 (95% CI, 0.582-0.712; p＜0.001) for AST. Serum ALT at 376 IU/L and AST at 635 IU/L had sensitivity and specificity comparable to ≥1,000 IU/L for defining severe DF.Conclusion: Liver-injury is common in DF. The ALT and AST levels increase with DF severity. ALT and AST levels of ≥1,000 IU/L could be lowered to 376 IU/L and 635 IU/L respectively for defining severe DF.

참고문헌 (Reference)

1 Barniol J, "Usefulness and applicability of the revised dengue case classification by disease: multi-centre study in 18 countries" 11 : 106-, 2011

2 Saha AK, "Spectrum of hepatic dysfunction in 2012 dengue epidemic in Kolkata, West Bengal" 32 : 400-403, 2013

3 Nanda Chhavi, "Serum Liver Enzyme Pattern in Birth Asphyxia Associated Liver Injury" 대한소아소화기영양학회 17 (17): 162-169, 2014

4 Schiff ER, "Schiff's diseases of the liver" Lippincott Williams & Wilkins 2007

5 Itha S, "Profile of liver involvement in dengue virus infection" 18 : 127-130, 2005

6 Roy A, "Profile of hepatic involvement by dengue virus in dengue infected children" 5 : 480-485, 2013

7 Seneviratne SL, "Pathogenesis of liver involvement during dengue viral infections" 100 : 608-614, 2006

8 Alexander N, "Multicentre prospective study on dengue classification in four South-east Asian and three Latin American countries" 16 : 936-948, 2011

9 Chongsrisawat V, "Liver function test results and outcomes in children with acute liver failure due to dengue infection" 40 : 47-53, 2009

10 Kye Mon K, "Incidence and clinical outcome of acute liver failure caused by dengue in a hospital for tropical diseases, Thailand" 95 : 1338-1344, 2016

11 Jagadishkumar K, "Hepatic involvement in dengue fever in children" 22 : 231-236, 2012

12 Poustchi H, "Gender differences in healthy ranges for serum alanine aminotransferase levels in adolescence" 6 : e21178-, 2011

13 Ling LM, "Fulminant hepatitis in dengue haemorrhagic fever" 38 : 265-268, 2007

14 Martinez Vega R, "Differences in liver impairment between adults and children with dengue infection" 94 : 1073-1079, 2016

15 World Health Organization, "Dengue: guidelines for diagnosis treatment prevention and control" WHO 147-, 2009

16 Ahmad S, "Dengue hepatitis sans dysfunction: experience of a single tertiary referral centre in the north Indian state of Uttarakhand" 43 : 62-65, 2013

17 World Health Organization, "Dengue haemorrhagic fever: diagnosis, treatment, prevention and control" WHO 84-, 1997

18 Lee LK, "Clinical relevance and discriminatory value of elevated liver aminotransferase levels for dengue severity" 6 : e1676-, 2012

19 Souza LJ, "Aminotransferase changes and acute hepatitis in patients with dengue fever: analysis of 1,585 cases" 8 : 156-163, 2004