Incidence of acute liver failure and its associated mortality in patients with dengue infection: A systematic review and meta-analysis

Acute liver failure (ALF) is a devastating consequence of dengue infection. This systematic review and meta-analysis assessed the incidence of ALF in dengue infection and its associated mortality. We systematically searched the EMBASE and MEDLINE databases from inception to December 2023 for observational studies reporting ALF incidence and mortality in dengue patients. Twenty-one studies encompassing 26,839 dengue-infected patients were included. Meta-analysis revealed a pooled incidence of ALF in cases of general dengue infection of 2.0 % (95 % CI, 1.2–3.0 %), with 1.2 % (95 % CI, 0.6–2.1 %) in adults and 5.0 % (95 % CI, 1.5–10.2 %) in children. ALF incidence was 17.3 % (95 % CI, 6.5 %−31.5 %) in severe dengue and 7.4 % (95 % CI, 0.8–18.5 %) in dengue shock syndrome. The pooled mortality rate of dengue-associated ALF was 47.0 % (95 % CI, 32.9–61.2 %). These findings underscore the detrimental impact of dengue infection on the development of the relatively uncommon, albeit life-threatening, condition of ALF.