Prevalence of transaminitis in pediatric dengue fever and its association with disease severity

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Background: Hepatic involvement is a common but under-characterized feature of pediatric dengue fever, particularly in India. Transaminitis, defined as elevated serum transaminase levels, is frequently observed in dengue and is included in the 2009 revised World Health Organization (WHO) dengue severity classification, with levels >1000 IU considered a marker of severe dengue. This study aims to determine the prevalence of transaminitis in pediatric dengue fever, to assess the prevalence of markedly elevated transaminase levels in severe dengue, to analyse the association of deranged liver function tests with disease severity, and to evaluate the predictive value of liver function tests in determining dengue disease severity. Methods: A retrospective cross-sectional study was conducted at a tertiary care centre in Kerala, including 159 children (age <18 years) with serologically confirmed dengue fever from 2009 to 2019. Demographic parameters (age, gender), biochemical tests (SGPT, SGOT, bilirubin, INR, albumin) and serological markers for dengue (NS1, IgM, IgG) were recorded. Transminitis was defined as SGOT or SGPT >50 IU/l. SGPT or SGOT >1000 IU/l was considered as marked elevation. Disease severity was classified as per the WHO criteria. Principal component analysis was used to derive composite liver indices. Ordinal logistic regression analysis assessed the predictors of disease severity. Results: 159 cases were analysed. 68.6% had dengue without warning signs, 27.0% had warning signs and 4.4% were diagnosed with severe dengue. Elevated SGOT and SGOT were observed in 77.4% and 45.9% respectively, indicating a high prevalence of transaminitis. Both composite liver indices (bilirubin and transaminases) were significantly associated with severe dengue and predicted higher disease severity (p=0.045 and 0.041 respectively). Albumin had a protective effect but it was marginally significant (p=0.057). INR, demographic and serological markers were not significantly associated with severity. Conclusions: Transminitis is highly prevalent in children with dengue fever and it corelates with the severity of illness. Routine liver enzyme evaluation early in the disease may improve risk assessment. More multicentre prospective studies are required to validate these findings and to investigate dynamic changes in liver function during the disease course.

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