Transaminitis and Gallbladder Wall Thickness as Predictors of Dengue Severity: A Retrospective Cross-sectional Study in ICU Patients

INTRODUCTION: Dengue fever, a viral hemorrhagic disease transmitted by Aedes mosquitoes, is a leading arthropod-borne infection, with 7.6 million cases reported globally and 30,000 cases in India in 2024.(1–3) It is prevalent in Southeast Asia and can range from self-limiting symptoms to severe complications such as hepatic injury and increased capillary permeability.(4) Transaminitis, characterised by elevated AST and ALT levels, indicates liver damage, while gallbladder wall thickening (GBWT > 5mm), which signals severe dengue risk, can be detected via ultrasonography.(5–7) Although the WHO criteria exclude GBWT, its rapid assessment could improve severity stratification. This study investigates transaminitis and GBWT (> 5mm) as predictors of dengue severity and clinical outcomes in ICU patients. OBJECTIVE: 1. To compare cases of gallbladder wall thickness (>5mm) in dengue with warning signs versus severe dengue cases. 2. To compare transaminitis in dengue with warning signs versus severe dengue cases. 3. To establish the relationship of gallbladder wall thickness((>5mm) with the length of ICU stay, mechanical ventilation, hemodialysis, and 28-day mortality. METHODS: A retrospective cross-sectional study was conducted on 120 patients with confirmed dengue serology admitted to Max Super Speciality Hospital, Ghaziabad, from July to November 2023. Patients were categorized into two groups: dengue with warning signs and severe dengue, based on WHO classification. Serum transaminase levels and gallbladder wall thickness were measured, and their correlations with clinical outcomes including ICU stay, mechanical ventilation, dialysis, and mortality were analysed. RESULTS: The study found that higher levels of SGOT and SGPT were significantly associated with severe dengue (p < 0.001). Gallbladder wall thickening (GBWT > 5mm) was observed in 75.93% of severe dengue patients and 54.55% of those with warning signs (p = 0.015). In patients with GBWT > 5mm, a statistically significant difference was observed in the need for mechanical ventilation (33.77 vs. 9.30%, p = 0.04) and dialysis (23.38% vs. 6.98%, p = 0.025). A significantly higher mortality rate was seen in patients with GBWT > 5mm (25.97% vs. 4.65%, p = 0.003). CONCLUSION: Transaminitis and increased gallbladder wall thickness are significant indicators of severe dengue, with potential utility in early risk stratification for patients at high risk of complications. These findings highlight the importance of monitoring these parameters to improve clinical decision-making in dengue management. KEYWORDS: Dengue fever, Severe Dengue, Gallbladder wall thickness (GBWT), Transaminitis, Dengue Severity.