Published online Dec 27, 2021. doi: 10.4254/wjh.v13.i12.1968
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.
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.