Pediatr Gastroenterol Hepatol Nutr.  2018 Oct;21(4):289-296. 10.5223/pghn.2018.21.4.289.

Validation of Serum Aminotransferases Levels to Define Severe Dengue Fever in Children

• Srivastava G
• Chhavi N
• Goel A

• KMID: 2421991
• DOI: http://doi.org/10.5223/pghn.2018.21.4.289

Abstract

PURPOSE
We aimed to study the pattern of liver-injury in children with dengue fever (DF) and validate serum aminotransferase ≥1,000 IU/L as a marker of severe DF.
METHODS
Children admitted with DF were included. DF was defined by presence of clinical criteria and positive serological or antigen tests in absence of other etiology. DF severity was graded as dengue without or with warning signs and severe dengue. Liver-injury was defined as alanine aminotransferase (ALT) more than twice the upper limit of normal (boys, 30 IU/L; girls, 21 IU/L).
RESULTS
Of 372 children with DF, 144 (38.7%) had liver-injury. Risk of liver-injury and aminotransferase levels increased with DF severity (p < 0.001). Recommended ALT and aspartate aminotransferase (AST) cut-off at ≥1,000 IU/L had sensitivity 4.8% (5/105), specificity 99.3% (265/267) for detection of severe DF. In children with ALT and AST < 1,000 IU/L (n=365), the area under receiver operating curves for prediction for severe DF, were 0.651 (95% confidence interval [CI], 0.588-0.714; p < 0.001) for ALT and 0.647 (95% CI, 0.582-0.712; p < 0.001) for AST. Serum ALT at 376 IU/L and AST at 635 IU/L had sensitivity and specificity comparable to ≥1,000 IU/L for defining severe DF.
CONCLUSION
Liver-injury is common in DF. The ALT and AST levels increase with DF severity. ALT and AST levels of ≥1,000 IU/L could be lowered to 376 IU/L and 635 IU/L respectively for defining severe DF.

Keyword

Dengue; Arbovirus; Mosquito borne febrile illness; Aedes aegypti; Dengue hepatitis

MeSH Terms

Alanine Transaminase
Arboviruses
Aspartate Aminotransferases
Child*
Dengue
Female
Fever*
Humans
Sensitivity and Specificity
Severe Dengue*
Transaminases*
Alanine Transaminase
Aspartate Aminotransferases
Transaminases

Figure

• 

  Fig. 1 Boxplot comparing the serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) enzymes in children with liver injury (n=372) and different grades of dengue fever severity. Outliers are represented as asterix (between 1.5–3.0 times of box length) and empty circle (>3 times of box lengths) from a hinge.

• 

  Fig. 2 Correlation between serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels in children with dengue fever and liver injury. Enzyme levels are expressed in multiples of upper limits of normal (ALT and AST cut-offs taken at 30 and 38 IU/L for boys and 21 and 33 IU/L for girls respectively).

• 

  Fig. 3 Boxplot comparing the serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) enzymes in children with liver injury (n=144) and different grades of dengue fever severity. Outliers are represented as asterix (between 1.5–3.0 times of box length) and empty circle (>3 times of box lengths) from a hinge.

• 

  Fig. 4 Receiver operating curve (ROC) revealing serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) level for prediction of severe dengue. AUROC: area under ROC.

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