Association between Specific Single Nucleotide Polymorphisms, Clinical Features and Severe Hepatitis in Dengue Patients
Abstract
Objective: This study aimed to identify predictors associated with severe hepatitis, especially genetic features, among
dengue patients.
Material and Methods: One hundred seventy nine dengue patients from the years 2009-2014 were identified from
the hospital inpatient database. Their baseline characteristics, laboratory data and hospital course were recorded and
analyzed. Seventy five patients had been tested for specific single nucleotide polymorphisms either the Janus kinase 1 (Jak1) or the cluster of differentiation 209 genes.
Results: Most of the identified study patients were female (64.8%), 74.3% had elevated liver enzymes, 48.6% of whom showed mild hepatitis. Serum aspartate aminotransferase was predominate over serum alanine aminotransferase (ALT) in most patients. Myalgia was the most common initial presentation (65.4%). Severe hepatitis (ALT ≥10 times the upper limit of normal) was associated with a higher intensive care unit (ICU) admission rate (26.3%) and complications (36.8%). There was significant elevation of liver enzymes among patients with initial platelets <50,000/microliter and albumin <3.5 gram (g)%. An initial serum albumin <3.5 g% had an odds ratio=4.16, 95% confidence interval 1.41-12.27 in association with severe hepatitis. No difference in specific single nucleotide polymorphisms was found between the severe liver involvement group and the mild group.
Conclusion: Liver involvement among dengue infection is frequent, mostly manifesting as mild transaminitis. Patients with severe hepatitis usually have poorer clinical outcomes due to complications and often require ICU admission. Initial serum albumin <3.5 g% appears to be a predictor associated with severe hepatitis and bad outcomes. The genetic susceptibility needs more study.
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