Clinical Relevance and Discriminatory Value of Elevated Liver Aminotransferase Levels for Dengue Severity

Abstract

BackgroundElevation of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) is prominent in acute dengue illness. The World Health Organization (WHO) 2009 dengue guidelines defined AST or ALT≥1000 units/liter (U/L) as a criterion for severe dengue. We aimed to assess the clinical relevance and discriminatory value of AST or ALT for dengue hemorrhagic fever (DHF) and severe dengue.Methodology/Principal FindingsWe retrospectively studied and classified polymerase chain reaction positive dengue patients from 2006 to 2008 treated at Tan Tock Seng Hospital, Singapore according to WHO 1997 and 2009 criteria for dengue severity. Of 690 dengue patients, 31% had DHF and 24% severe dengue. Elevated AST and ALT occurred in 86% and 46%, respectively. Seven had AST or ALT≥1000 U/L. None had acute liver failure but one patient died. Median AST and ALT values were significantly higher with increasing dengue severity by both WHO 1997 and 2009 criteria. However, they were poorly discriminatory between non-severe and severe dengue (e.g., AST area under the receiver operating characteristic [ROC] curve = 0.62; 95% confidence interval [CI]: 0.57–0.67) and between dengue fever (DF) and DHF (AST area under the ROC curve = 0.56; 95% CI: 0.52–0.61). There was significant overlap in AST and ALT values among patients with dengue with or without warning signs and severe dengue, and between those with DF and DHF.ConclusionsAlthough aminotransferase levels increased in conjunction with dengue severity, AST or ALT values did not discriminate between DF and DHF or non-severe and severe dengue.

Demographic and Clinical Features of Patients with Dengue in Northeastern Region of India: A Retrospective Cross-Sectional Study during 2009-2011

“…The percentage of positive cases having headache, eye pain and vomiting were significantly higher during the acute phase of the illness than that in the negative cases. These common clinical features in typical dengue infection were also observed in other published studies (Pérez-Guerra et al, 2005;Chuang et al, 2008;Lee et al, 2012). Our laboratory data showed that the percentage of dengue patients with mean elevated level of Aspartate transaminase and Alanine transaminase were significantly higher than that of laboratory dengue negative patients.…”

Assessment of Dengue Fever Severity Through Liver Function Test

“…The reversal of alanine transaminase and aspartate transaminase (AST/ALT) ratio is helpful to diferentiate it from other acute viral hepatitis like HAV, HBV, HCV, etc., where this is rarely seen except in alcoholic hepatitis [6].…”

“…Involvement of liver with deranged liver function tests (LFTs) is likely with dengue fever and which may include mildly raised in serum total bilirubin, increased alanine transaminase (ALT) and aspartate transaminase (AST), and decreased in serum albumin which can be a used as a prognostic indicator [6].…”

“…But it can still lead to acute fulminant hepatic failure in dengue-afected countries. Dengue should be a diferential in management of acute fulminant hepatic failure and as a triggering factor in patient with acute on chronic liver failure [6].…”

<b>Profile of hemogram and transaminases in dengue-suspected patients at a first-aid health unit

“…Other tests, such as hepatic enzyme dosage, are required when dengue with liver condition is suspected. Rise of aspartate aminotransferase hepatic (AST) and alanine aminotransferase (ALT) enzymes is common in acute infection cases by dengue and increases during the disease´s convalescence period (from the 7 th to the 10 th day) (LEE et al, 2012). Hemogram with platelet counts is a great help in acknowledging the presence of hemorrhagic dengue since the decrease in lymphocytes and platelet counts are associated with this serious type of the disease (BRASIER et al, 2012).…”