Hepatic Dysfunction in Children with Dengue Shock Syndrome

A study was conducted in Thailand during 2002–2005 in children with dengue shock syndrome (DSS) for associated hepatic dysfunction and its consequences. Among 38 children with DSS, 13 (34.2%) had hepatic dysfunction with a mean alanine aminotransferase level of 1466.9 U/litre compared to 83.1 U/ litre in those without it. Hepatic dysfunction occurred in 25.8% of children with dengue haemorrhagic fever grade 3, and 71.4% with grade 4 (P=0.034). There was spontaneous bleeding in 76.9% of children with hepatic dysfunction and in 64.0% of those without (P=0.333). Spontaneous bleeding also correlated with disease severity: 61.3% of children in grade 3 and 100% in grade 4 (P=0.052) had bleeding. There was no statistically significant difference in haematocrits, platelets, aminotransferase levels, coagulograms and carbon dioxide between the two groups of children who bled and who did not. Four children died from fulminant hepatic failure; all of them had acidosis and abnormal coagulograms. Hepatic dysfunction is common in children with DSS; spontaneous bleeding should be expected.