title: Frequency of worsening liver function in severe dengue hepatitis patients receiving paracetamol: A retrospective analysis of hospital data.
abstract: OBJECTIVE
  To determine the frequency of worsening liver function among hospital in-patients with severe dengue hepatitis receiving paracetamol.
  
  
  METHODS
  This retrospective study was conducted at the Department of Medicine, Aga Khan University Hospital, Karachi, and comprised records of dengue patients with severe hepatitis who received paracetamol for control of fever between June 2007 and December 2014. Alanine aminotransferase at baseline and following paracetamol administration was noted, as well as dosage and duration of paracetamol, along with participants' demographic details. Frequency of patients who developed worsening or improvement of alanine aminotransferase was also noted. SPSS 19 was used for data analysis.
  
  
  RESULTS
  Of the 113 subjects, 73(64.6%) were male and 40(35.4%) were female. Overall improvement was observed in subsequent alanine aminotransferase levels (491 units per litre, IQR 356.5 TO 775 vs 151 units per litre, IQR 49.5 to 299.5). Most commonly prescribed dose of paracetamol was 2g (IQR 1 to 5 grams), which was taken for a median duration of 1 day (IQR 1 to 3 days). Moreover, 100(88.5 %) patients showed improvement in alanine aminotransferase. Only 13(11.5 %) patients developed worsening of alanine aminotransferase. Of those with worsening liver function, 8(61.5 %) were discharged home with no clinical deterioration and 5(38.5 %) deaths were observed. However, causes of deaths were unrelated to liver dysfunction.
  
  
  CONCLUSIONS
  The frequency of worsening liver function following paracetamol administration in patients with severe dengue hepatitis was relatively low.
authors.affiliation: Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Ahsan Ali
authors.initials: AA
authors.lastname: Syed
authors.affiliation: Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Faisal
authors.initials: F
authors.lastname: Aslam
authors.affiliation: Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Haris
authors.initials: H
authors.lastname: Hakeem
authors.affiliation: Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Faraz
authors.initials: F
authors.lastname: Siddiqui
authors.affiliation: Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Noreen
authors.initials: N
authors.lastname: Nasir
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects* / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006505:Hepatitis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000503:physiopathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D012189:Retrospective Studies; D019595:Severe Dengue / Q000188:drug therapy / Q000453:epidemiology; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen
keywords: Dengue, Hepatitis, Paracetamol, Liver dysfunction.