LFT RESULTS AND OUTCOMES IN ALF DUE TO DENGUE INFECTION Vol 40 No. 1 January 2009 47 Correspondence: Professor Yong Poovorawan, Center of Excellence in Clinical Virology, Depart- ment of Pediatrics, Faculty of Medicine, Chulalongkorn University and Hospital, Rama IV Road, Patumwan, Bangkok 10330, Thailand. Tel: 66 (0) 2256 4909; Fax: 66 (0) 2256 4929 E-mail: yong.p@chula.ac.th LIVER FUNCTION TEST RESULTS AND OUTCOMES IN CHILDREN WITH ACUTE LIVER FAILURE DUE TO DENGUE INFECTION Voranush Chongsrisawat 1 , Yanee Hutagalung 2 and Yong Poovorawan 1 1 Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and Hospital, Bangkok; 2 Glaxo SmithKline, Thailand Abstract. This retrospective study compared the liver function test results and out- comes between children with acute liver failure (ALF) due to dengue hemorrhagic fever (DHF) and due to other causes. We retrospectively reviewed patients less than 15 years old with a diagnosis of ALF admitted to 13 participating centers from differ- ent parts of Thailand for the years 2000 and 2001, and those admitted to King Chulalongkorn Memorial Hospital for the year 1997 to 2004. The diagnosis of ALF was based on prothrombin time (PT) prolongation to greater than 2 times the normal control value and the presence of encephalopathy without pre-existing liver disease. The patients were divided into 2 groups: group I (n=16) had DHF with ALF and group II (n=37) had ALF due to other causes. DHF patients had AST levels significantly higher than ALT levels. The mortality rate in group I (50%) was lower than in group II (72.9%), although the difference was not statistically significant. The non-DHF patients who died had a significantly longer duration of jaundice before the onset of encephal- opathy and a significantly higher PT ratio compared to survivors. There were no signifi- cant differences in the duration of jaundice before the onset of encephalopathy and liver function between dengue patients who died and those who survived. INTRODUCTION Dengue infection is prevalent in tropi- cal countries. It has been estimated that at least 2.5 billion people worldwide live in areas where there is a significant risk of in- fection from the dengue virus (WHO, 1999). Estimates suggest that annually over 50 mil- lion cases of dengue infection and about 400,000 cases of dengue hemorrhagic fever (DHF) occur in Asian countries with a case fatality rate of less than 5% (WHO, 1999; Deen et al, 2006). Of those with DHF, at least 90% are children younger than 15 years old (WHO, 1999). Infection with dengue virus can cause a spectrum of illnesses including asymptom- atic, fever and relatively mild disease, known as classic dengue fever (DF), a more severe form known as DHF and less fre- quently acute hepatitis with liver failure and encephalopathy. Acute liver failure (ALF) caused by dengue virus has been reported, mostly in case reports and small case series (Alvarez and Ramirez-Ronda et al, 1985; George et al, 1988; Lum et al, 1993). The un- usual clinical forms of this disease are fre- quently associated with more serious states, and they often result from multifactorial con-