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บทคัดย่อ

          A prospective observation study was conducted in children with dengue shock syndrome for associated hepatic dystunction and its consequence. Among 34 children with DSS, 11 (32.4%) had hepatic dysfunction with mean of alanine aminotransferase level of 1,412 U/liter compared to 86 in those without hepative dysfunction. It occurred in 25% of children with dengue hemorrhagic fever grade 3, and 67% with grade 4. There was spontaneous bleeding in 82% of children with hepatic dysfunction and in 70% of those without (p=0.682). Spontaneous bleeding also correlated with disease severity, 68% of children in grade 3 and 100% in grade 4, with high level of alanine aminotransferase (647 vs. 149 U/liter) as an early indicator. Thrombocytopenia was present in all cases as well as minor prolongations of prothrombin and partial thromboplastin times. Three children died from fulminant hepatic failure. All of them had acidosis and abnormal coagulograms. Hepatic dysfunction is common in children with DSS; spontaneous bleeding should be alerted especially when aminotransferase levels are high.