ELEVATED ALANINE AMINOTRANSFERASE AS A SEVERITY INDICATOR IN DENGUE FEVER

Objective: The aim of this cross sectional and comparative study is to find out the frequency of elevated alanine aminotransferase in dengue fever and its association with the severity of illness. Methodology: This study was performed in the medical unit of Hayatabad Medical Complex Peshawar from Sep to Nov 2021. Total 243 patients, 147 males and 96 females, were included in this study. Patients were consecutively collected from the wards and medical outpatients department, both who needed admission to the hospital and those who could be managed as outpatient. The age range of the patients was 15 to 69 years. The patients with compatible history and clinical examination were diagnosed on dengue antigen test the dengue NS1. After diagnosis, the patients were subjected to different other investigations like liver enzymes and functions, renal function and peripheral blood smear. Those patients who were with other co morbidities like congestive heart failure, chronic kidney and liver diseases or acute viral hepatitis, were excluded from the study. Persistent vomiting, plasma leak as evident by pleural effusion or ascites and any type of hemorrhage were taken as warning signs for severe dengue. Results: This study included 243 patients with dengue NS1 positive dengue fever.  Male patients were 147 (60.5%) while females were 96 (39.5%). The age range was 15 to 74 years (mean 38.6 & SD +_18.45). The frequency of elevated alanine aminotransferase of 80U/L or more was found to be 51.44% (n=125) while the frequencies of elevated alanine aminotransferase in different age and gender groups were not significantly different from each other’s values (Table 1). Elevated alanine aminotransferase was found in 28% of the patients without severity signs, 73.4% of the patients with persistent vomiting, 63.4% of the patients with Plasma leak as evident by pleural effusion or ascites and 62.12% of the patients with hemorrhage (Table 2). Table 3 and figure-1 shows correlation of the elevated ALT with the three mentioned warning signs for severity of dengue fever. Conclusion: Elevated alanine aminotransferase level is an important indicator for severity of dengue fever. Elevated alanine aminotransferase level of more than 300U/L has strong association with persistent vomiting, plasma leak and hemorrhage.