背景:登革热是病毒性出血热的最常见原因,每年报告的病例超过4亿例,全世界。尽管肝脏受累很常见,急性肝衰竭(ALF)是登革热的罕见并发症。
目的:为了分析人口统计概况,症状学,通过回顾已发表的病例报告,观察登革热感染继发ALF患者的住院过程和结果。
方法:从包括PubMed、参考引文分析,科学直接,谷歌学者。使用的搜索词为\"登革热\"或\"严重登革热\"或\"登革热休克综合征\"或\"登革热出血综合征\"或\"登革热\"和\"急性肝衰竭\"或\"肝衰竭\"或\"肝损伤\"。纳入标准是:(1)病例报告或病例系列与个别患者的细节;(2)报告的急性肝衰竭继发于登革热感染;(3)以英语和成人发表。数据是根据患者的人口统计学提取的,临床症状学,临床干预措施,医院和重症监护室课程,需要器官支持和临床结果。
结果:纳入了符合预定纳入标准的19例病例报告的数据。患者的中位年龄为38岁(四分位距:Q3-Q126.5岁),女性占优势(52.6%)。从登革热诊断到ALF发展的中位天数为4.5d。天冬氨酸转氨酶的升高高于丙氨酸转氨酶(中位数4625U/Lvs3100U/L)。所有患者都有一个或多个器官衰竭,73.7%的患者出现神经功能衰竭。42.1%的患者需要血管加压药支持,肝性脑病是13例(68.4%)中报告最多的并发症。大多数患者接受了保守治疗,2例患者接受了肝移植。仅报告1例死亡(5.3%)。
结论:登革热感染很少导致ALF。这些患者可能经常需要重症监护和器官支持。即使这些患者中的大多数可以通过支持性治疗改善,肝移植可能是难治性病例的治疗选择。
BACKGROUND: Dengue fever is the most common cause of viral hemorrhagic fever, with more than 400 million cases being reported annually, worldwide. Even though hepatic involvement is common, acute liver failure (ALF) is a rare complication of dengue fever.
OBJECTIVE: To analyze the demographic profile, symptomology, hospital course and outcomes of patients presenting with ALF secondary to dengue infection by reviewing the published
case reports.
METHODS: A systematic search was performed from multiple databases including PubMed, Reference Citation Analysis, Science Direct, and Google Scholar. The search terms used were \"dengue\" OR \"severe dengue\" OR \"dengue shock syndrome\" OR \"dengue haemorrhagic syndrome\" OR \"dengue fever\" AND \"acute liver failure\" OR \"hepatic failure\" OR \"liver injury\". The inclusion criteria were: (1)
Case reports or
case series with individual patient details; (2) Reported acute liver failure secondary to dengue infection; and (3) Published in English language and on adult humans. The data were extracted for patient demographics, clinical symptomatology, clinical interventions, hospital and intensive care unit course, need for organ support and clinical outcomes.
RESULTS: Data from 19
case reports fulfilling the predefined inclusion criteria were included. The median age of patients was 38 years (inter quartile range: Q3-Q1 26.5 years) with a female preponderance (52.6%). The median days from diagnosis of dengue to development of ALF was 4.5 d. The increase in aspartate aminotransferase was higher than that in alanine aminotransferase (median 4625 U/L vs 3100 U/L). All the patients had one or more organ failure, with neurological failure present in 73.7% cases. 42.1% patients required vasopressor support and hepatic encephalopathy was the most reported complication in 13 (68.4%) cases. Most of the patients were managed conservatively and 2 patients were taken up for liver transplantation. Only 1 death was reported (5.3%).
CONCLUSIONS: Dengue infection may rarely lead to ALF. These patients may frequently require intensive care and organ support. Even though most of these patients may improve with supportive care, liver transplantation may be a therapeutic option in refractory cases.