Assessment of Severity of Dengue Fever by Deranged Alanine Aminotransferase Levels

Introduction Dengue fever (DF) is the most common arbovirus-related infection worldwide. Most of the dengue infections are asymptomatic. The clinical presentation of DF varies from mild febrile illness to dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Both DHF and DSS are severe forms of illness and carry higher rates of mortality. Various clinical parameters are associated with severe DF. The objective of this study was to determine any relation between elevated alanine aminotransferase (ALT) levels at presentation and development of severe DF. Methods This cross-sectional study was carried out at a large tertiary care hospital in Rawalpindi, Pakistan. Over a period of six months, 65 dengue patients were enrolled and their ALT levels were recorded at presentation. All the patients were managed as per guidelines in a similar way, and clinical course was followed for the development of severe forms of DF, such as DHF and DSS. Results Out of total 65 patients, 45 (69.2%) were males and 20 (30.8%) were females. Classical DF was present in 18 (27.7%) patients, whereas 47 (72.3%) patients developed DHF or DSS. Patients with DF had a mean ALT level of 131.67 (±244.48) U/L at presentation, whereas patients with DHF and DSS had a mean ALT level of 228.15 (±467.88) U/L at presentation. The Mann-Whitney U test was applied to compare differences between ALT levels of both groups, and p value was found to be 0.018 (<0.05). Thus, it was concluded that there was a statistical difference between ALT levels of patients with simple DF and patients with DHF or DSS.  Conclusion Higher serum levels of ALT at presentation can give a clue about possibility of progression to severe forms of DF (DHF and DSS). Therefore, patients with higher ALT at presentation should be prioritized and monitored more rigorously.