Aminotransferase Elevation as an Independent Predictor of Severity and Mortality in Dengue Fever: A Prospective Cohort Study from Western India

Background: Hepatic involvement is a frequent but often underestimated manifestation of dengue infection. Elevation of liver enzymes reflects both hepatocellular injury and systemic inflammatory response and may provide valuable prognostic information for assessing disease severity and outcome. Aim: This study aimed to evaluate the prognostic significance of aminotransferase, namely aspartate aminotransferase (AST) and alanine aminotransferase (ALT) elevation in dengue fever (DF) and its correlation with disease severity, thrombocytopenia, duration of hospitalisation and mortality. Methods: A prospective observational study was conducted on 250 serologically confirmed dengue patients admitted to a tertiary-care hospital in Jaipur, Rajasthan, between October 2019 and November 2020. Patients with pre-existing liver disease, viral hepatitis or hepatotoxic drug exposure were excluded. Clinical and biochemical parameters were analysed in accordance with the World Health Organisation (WHO) 2009 dengue classification and aminotransferase levels were categorised based on multiples of the upper limit of normal (ULN). Results: Elevated AST and ALT levels were observed in 92% and 87.6% of patients, respectively. Mild to moderate elevation (2–10× ULN) was most frequent, while 13.6% of patients exhibited marked elevation (>10× ULN). Severe hepatic enzyme elevation was significantly associated with dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS), prolonged hospital stay (6.2 ± 1.5 days versus 4.1 ± 1.1 days, P < .05) and mortality (80% of deaths). Platelet count showed a negative correlation with AST ( r = –0.32, P = .002) and ALT ( r = –0.35, P = .001), suggesting that greater hepatic dysfunction paralleled worsening thrombocytopenia. Conclusion: Marked aminotransferase elevation (>10× ULN), particularly of AST, serves as a reliable biochemical indicator of severe dengue and adverse outcomes. Early liver function assessment, when combined with haematological monitoring, offers a simple and cost-effective tool for triage and prognostication in dengue management within resource-limited settings.