CORRELATION OF LIVER ENZYMES (AST/ALT) WITH CLINICAL OUTCOMES IN CHILDREN WITH DENGUE

Abstract

Background:Dengue fever is a major vector-borne viral illness with significant health consequences,particularly in tropical and subtropical regions. In Punjab, Pakistan, liver involvement, reflected byelevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, has beenobserved in dengue patients. However, the relationship between liver enzyme profiles and clinicaloutcomes in pediatric dengue remains underexplored.Objective:To assess the association betweenliver enzyme (AST/ALT) levels and clinical outcomes in children with dengue in Punjab, Pakistan,focusing on disease severity, complications, and hospitalization duration.
Methods:Aprospective,observational, multicenterstudywas conducted atthreetertiary carehospitalsinMultan,Ibn-e-Siena Hospital & Research Institute, Nishtar Hospital & The ChildrenHospital & the Institute of Child Health, Multan,Punjab, fromAugustto December 2025. Pediatricpatients aged 1–12 years with confirmed dengue fever, diagnosed based on positive NS1 or IgMantibody tests, were included. Data on liver enzyme levels (AST/ALT), clinical severity (DengueFever, Dengue Hemorrhagic Fever [DHF], Dengue Shock Syndrome [DSS]), complications, andhospital stay were collected. Statistical analyses includedANOVA,Pearson’s correlation, andlogisticregression, with theROC curveused to determine the predictive value of AST/ALT levels for severedisease.
Results:The study included200 pediatric patients.AST levelswere significantly higher in DHF (230± 80 U/L) and DSS (315 ± 110 U/L) compared to Dengue Fever (120 ± 45 U/L). Similarly,ALTlevelswere elevated in severe cases (DHF: 210 ± 85 U/L, DSS: 290 ± 105 U/L). A significant positivecorrelation was observed betweenAST levelsandhospital stay(r = 0.68, p < 0.001). Elevated AST
(>220 U/L) was a significant predictor of severe dengue, with anAUC of 0.85in the ROC analysis.Complicationswere more common in DHF (55%) and DSS (70%) cases, withlonger hospital stays
(Dengue Fever: 5.3 ± 1.2 days, DHF: 7.8 ± 2.3 days, DSS: 10.2 ± 3.5 days).

Conclusions:ElevatedAST/ALT levelsare significantly associated withsevere dengueand canserve as predictive biomarkers for disease severity, complications, and hospital stay in pediatricdengue cases. Routine liver enzyme testing, particularly AST, may help in early risk stratification andguide clinical management. Further multi-center studies are needed to validate these findings.