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

Abstract

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 by elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, has been observed in dengue patients. However, the relationship between liver enzyme profiles and clinical outcomes in pediatric dengue remains underexplored. Objective: To assess the association between liver enzyme (AST/ALT) levels and clinical outcomes in children with dengue in Punjab, Pakistan, focusing on disease severity, complications, and hospitalization duration.
Methods: A prospective, observational, multicenter study was conducted at three tertiary care hospitals in Multan, Ibn-e-Siena Hospital & Research Institute, Nishtar Hospital & The Children Hospital & the Institute of Child Health, Multan, Punjab, from August to December 2025. Pediatric patients aged 1–12 years with confirmed dengue fever, diagnosed based on positive NS1 or IgM antibody tests, were included. Data on liver enzyme levels (AST/ALT), clinical severity (Dengue Fever, Dengue Hemorrhagic Fever [DHF], Dengue Shock Syndrome [DSS]), complications, and hospital stay were collected. Statistical analyses included ANOVA, Pearson’s correlation, and logistic regression, with the ROC curve used to determine the predictive value of AST/ALT levels for severe disease.
Results: The study included 200 pediatric patients. AST levels were significantly higher in DHF (230 ± 80 U/L) and DSS (315 ± 110 U/L) compared to Dengue Fever (120 ± 45 U/L). Similarly, ALT levels were elevated in severe cases (DHF: 210 ± 85 U/L, DSS: 290 ± 105 U/L). A significant positive correlation was observed between AST levels and hospital stay (r = 0.68, p < 0.001). Elevated AST (>220 U/L) was a significant predictor of severe dengue, with an AUC of 0.85 in the ROC analysis. Complications were more common in DHF (55%) and DSS (70%) cases, with longer hospital stays (Dengue Fever: 5.3 ± 1.2 days, DHF: 7.8 ± 2.3 days, DSS: 10.2 ± 3.5 days).
Conclusions: Elevated AST/ALT levels are significantly associated with severe dengue and can serve as predictive biomarkers for disease severity, complications, and hospital stay in pediatric dengue cases. Routine liver enzyme testing, particularly AST, may help in early risk stratification and guide clinical management. Further multi-center studies are needed to validate these findings.