Liver involvement in dengue: A systematic review.

Area of Science:

• Hepatology
• Infectious Diseases
• Clinical Medicine

Background:

• Liver involvement is an uncommon but often missed complication of dengue fever.
• Accurate characterization of dengue-associated liver injury is vital for effective clinical management and prognosis.
• Early diagnosis relies on understanding clinical presentation, biological markers, and associations with severe dengue.

Purpose of the Study:

• To systematically review and synthesize the clinical and biological characteristics of dengue-associated liver involvement.
• To identify prognostic factors, associations with severe dengue, and optimal clinical management strategies.
• To provide a comprehensive overview for efficient diagnosis and patient care.

Main Methods:

• A systematic review was conducted using PubMed and Web of Science databases.
• Included original case reports, cohort, and cross-sectional studies on dengue-associated liver involvement.
• The review was registered with PROSPERO (CRD42021262657).

Main Results:

• Dengue-associated liver involvement presents with abdominal pain, hepatomegaly, jaundice, and nausea/vomiting, showing hepatocellular necrosis on ultrasound.
• Elevated liver enzymes (AST, ALT), bilirubin, ALP, GGT, INR, creatinine, and CK, with decreased albumin, were prevalent.
• Strong association with severe dengue, cardiovascular/hematological complications, more common in males and older adults, linked to DENV-2 and secondary infections.

Conclusions:

• Early monitoring of transaminases, clinical assessment, and ultrasound are key for diagnosing dengue-associated liver involvement.
• This approach facilitates early identification and management of severe dengue cases.
• Conservative management is typically employed, with early paracetamol use noted as a risk factor.