Elevated liver enzyme (AST and ALT) as biomarkers for severe dengue in Nepalese patients: a cross-sectional study

Elevated AST as a significant independent predictor of dengue with warning signs, and may serve as a valuable biomarker for early risk stratification. Additionally, female sex emerged as an independent risk factor for severe disease, a novel finding with potential implications for sex-specific risk stratification. The findings highlight the importance of liver function monitoring in dengue management. Despite strengths in structured assessment and comprehensive analysis, limitations including the cross-sectional design, convenience sampling, and fewer-center setting limit causal inference and generalizability. Future studies should validate these findings through prospective, multi-center research and explore sex-based risk profiles and the prognostic utility of dynamic liver enzyme monitoring.