LIVER INJURY IN CHILDREN WITH DENGUE SHOCK SYNDROME AT CHILDREN’S HOSPITAL 1
Main Article Content
Abstract
Background: Liver injury is common in children with dengue shock syndrome (DSS) and may be associated with disease severity and mortality. However, the prognostic value of the dynamic changes of liver injury during the shock phase in pediatric patients has not been fully elucidated.
Methods: A longitudinal study was conducted at the Emergency Department and Pediatric Intensive Care Unit of Children’s Hospital 1 from January 1, 2021 to December 31, 2023. Children aged 1 month to 15 years diagnosed with DSS and laboratory-confirmed dengue infection were enrolled. Liver injury parameters were monitored from the onset of shock throughout treatment. Receiver operating characteristic (ROC) curve analysis and multivariable logistic regression were performed to evaluate predictors of mortality.
Results: A total of 113 children were included; the median age was 8.9 (6.4–12.1) years, and 61% were male. The overall mortality rate was 15%. At shock onset, the median AST level was 332 IU/L; 24.8% had AST >1000 IU/L. AST levels were significantly higher in non-survivors than in survivors at all time points (p<0.001). The area under the ROC curve (AUC) of AST increased over time: 0.809 at T0, 0.872 at T1, and 0.913 at T2. The optimal AST cut-off was 319 IU/L at T0 (sensitivity 100%, specificity 55.1%) and 1366 IU/L at a later time point (sensitivity 94.1%, specificity 82%). In multivariable analysis, severe shock, prolonged shock, and AST >1000 IU/L were independent predictors of mortality.
Conclusion: The dynamic changes of AST within the first 48 hours provide significant prognostic value for mortality in children with DSS and may enhance early risk stratification when combined with clinical factors.
Keywords
dengue shock syndrome, children, liver injury, AST, prognosis
Article Details
References
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