Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 27, 2021; 13(12): 1968-1976
Published online Dec 27, 2021. doi: 10.4254/wjh.v13.i12.1968
Dengue hemorrhagic fever and the liver
Wattana Leowattana, Tawithep Leowattana
Wattana Leowattana, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Bangkok, Thailand
Tawithep Leowattana, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Bangkok 10110, Bangkok, Thailand
Author contributions: Leowattana W wrote the paper; Leowattana T collected the data.
Conflict-of-interest statement: Authors declare no conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Wattana Leowattana, BSc, MD, MSc, PhD, Associate Professor, Senior Researcher, Staff Physician, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajavithi Road, Rachatawee, Bangkok 10400, Bangkok, Thailand.
Received: March 5, 2021
Peer-review started: March 5, 2021
First decision: March 29, 2021
Revised: March 30, 2021
Accepted: November 13, 2021
Article in press: November 13, 2021
Published online: December 27, 2021

Dengue hemorrhagic fever (DHF) is one of the most rapidly emerging infections of tropical and subtropical regions worldwide. It affects more rural and urban areas due to many factors, including climate change. Although most people with dengue viral infection are asymptomatic, approximately 25% experience a self-limited febrile illness with mild to moderate biochemical abnormalities. Severe dengue diseases develop in a small proportion of these patients, and the common organ involvement is the liver. The hepatocellular injury was found in 60%-90% of DHF patients manifested as hepatomegaly, jaundice, elevated aminotransferase enzymes, and critical condition as an acute liver failure (ALF). Even the incidence of ALF in DHF is very low (0.31%-1.1%), but it is associated with a relatively high mortality rate (20%-68.3%). The pathophysiology of liver injury in DHF included the direct cytopathic effect of the DENV causing hepatocytes apoptosis, immune-mediated hepatocyte injury induced hepatitis, and cytokine storm. Hepatic hypoperfusion is another contributing factor in dengue shock syndrome. The reduction of morbidity and mortality in DHF with liver involvement is dependent on the early detection of warning signs before the development of ALF.

Keywords: Dengue hemorrhagic fever, Dengue viral infection, Liver involvement, Liver injury, Acute liver failure, Hepatocyte apoptosis, Cytokine storm, Severe dengue disease

Core Tip: The liver is the most common organ involvement in dengue hemorrhagic fever (DHF) patients with ranges from mild subclinical biochemical changes to severe liver disease as an acute liver failure (ALF). However, the low incidence of ALF in DHF with liver injury is associated with a high fatality rate. The hepatocyte injury is caused by direct viral cytopathic, immune-mediated, and poor hepatic perfusion. Early detection of severe hepatocellular injury development may reduce the morbidity and mortality in DHF patients with liver involvement.