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Access Type

Open Access Thesis

Document Type


Degree Program

Public Health

Degree Type

Master of Science (M.S.)

Year Degree Awarded


Month Degree Awarded



Severe liver and kidney dysfunction are prevalent in 10%-30% of the Southeast Asian population. Dengue virus infection has been reported as a modifiable risk factor for liver and kidney dysfunction, especially among children in Southeast Asia. Epidemiologic studies assessing this relationship are sparse, often failed to include children, and did not adjust for important covariates. Therefore, we evaluated the relationship between dengue virus infection and liver and kidney dysfunction among hospitalized children in Cambodia (n=551). Participants with a serologically confirmed dengue virus infection were categorized according to increasing severity of infection (i.e. dengue fever, dengue hemorrhagic fever, or dengue shock syndrome) using clinical assessment. Laboratory assays were used to assess liver (i.e. albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total protein) and kidney protein levels (i.e. creatinine and urea). Descriptive statistics were used to assess the impact of severity of dengue virus infection on kidney dysfunction. Additionally, descriptive statistics and linear mixed modeling were used to assess the impact of severity of dengue virus infection on liver dysfunction while adjusting for important risk factors. Approximately 75% of all participants had abnormal liver or kidney protein level(s) over the first four days of follow-up. Overall, a negative association was observed between increasing dengue disease severity and albumin (ßadj = -0.08, 95% CI = -0.45 to 0.29), ALT (ßadj = -18.02, 95% CI = -51.59 to 15.55), and AST (ßadj = -7.18, 95% CI = -49.57 to 35.21) protein levels. A positive association was observed between increasing dengue disease severity and total protein levels (ßadj = 7.14, 95% CI = 1.15 to 13.13). While abnormal liver function (increases in ALT and/or AST levels and decreases in albumin and/or total protein levels) is a common clinical finding in dengue infections, we did not find evidence for a significant association with more severe forms of dengue virus infection (i.e. dengue hemorrhagic fever or dengue shock syndrome) and greater liver dysfunction as compared to patients with dengue fever in pediatric populations in Cambodia.


First Advisor

Andrew Lover

Second Advisor

Cassana N. Spracklen