Hepatic Dysfunction in Dengue Virus Infection: Spectrum, Severity, and Prognostic Implications

Abstract

Background: Liver involvement is a well-recognised complication of dengue virus infection, yet its frequency, pattern, and relationship to disease severity remain incompletely characterised in adult populations from endemic regions. Objective: This retrospective study evaluated the nature and extent of hepatic biochemical disturbances across the clinical spectrum of dengue illness and identified markers associated with adverse outcomes. Methods: Records of 196 laboratory-confirmed adult dengue cases with complete liver function test (LFT) data were examined. Cases were categorised as dengue fever (DF), dengue haemorrhagic fever (DHF), and dengue shock syndrome (DSS) according to standard WHO criteria. Hepatic parameters assessed included serum bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), serum albumin, and the international normalised ratio (INR). Results: Elevated transaminases were the predominant abnormality, with AST and ALT exceeding the upper limit of normal in 95.4% and 91.8% of patients respectively. A disproportionate rise in AST relative to ALT was consistently observed (mean AST 328.4 ± 44.1 U/L vs. ALT 202.7 ± 29.5 U/L; p = 0.021). Hyperbilirubinaemia (22.1%), hypoalbuminaemia (27.6%), and elevated ALP (34.2%) were less frequent. Patients with DSS showed significantly greater derangement across all hepatic parameters versus DF patients. Bilirubin, ALT, and ALP were markedly elevated in the setting of haemorrhage, secondary infection, and among non-survivors. Conclusions: Transaminase elevation is near-universal in dengue infection, with preferential AST rise serving as an early diagnostic pointer. Hyperbilirubinaemia and elevated ALP and ALT are associated with haemorrhagic complications, re-infection, and mortality, suggesting their utility as prognostic biomarkers in dengue management.