Serum Aminotransferase levels in the assessment of severity of dengue fever

Govindarajan, B (2014) Serum Aminotransferase levels in the assessment of severity of dengue fever. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Dengue fever is highly prevalent in Tamilnadu and it has caused several outbreaks in the recent years .Notable areas involved in the recent outbreaks includes Chennai, Madurai and Tirunelveli with significant mortality and morbidity. Most patients with dengue fever have liver involvement in the form of elevated serum aminotransferases. The elevation of enzymes is due to reactive hepatitis as well as direct injury to hepatocytes by the virus itself. Patients with hepatitis are more likely to have increased risk of bleeding tendencies, renal failure, encephalopathy and acalculous cholecystitis. In addition to thrombocytopenia, deranged liver function plays a significant role in bleeding. Hence, evaluation of liver function, particularly the aminotransferases, should be a routine in the management of dengue fever. METHODS : A total of 60 patients with dengue IG-M ELISA positive admitted to Institute of Internal Medicine, Rajiv Gandhi Government General Hospital, Chennai were included in this study. Patients have their history taken according to a questionnaire and subjected to clinical examination and investigations like complete blood count, plasma glucose, blood urea, serum creatinine, QBC for MP/MF, MSAT for leptospirosis, blood culture, widal test, anti-HAV, HBsAg, anti HCV, chest X- ray, USG abdomen and liver function tests. RESULTS : Out of 60 patients, 36 patients had elevated liver enzymes. Those patients were at risk of severe bleeding, shock, ARDS, hepatitis and other complications. There was a significant difference (p value<0.05) between serum aminotransferase values and bleeding, shock, ARDS and hepatitis. There was a negative correlation between liver enzymes and platelets. Of the liver enzymes, AST levels were higher compared to ALT levels (mean AST-259.45& mean ALT- 199.75). CONCLUSION : Hepatic involvement is common in dengue fever. It is characterised by elevated liver enzymes, AST more than ALT levels. Elevated liver enzymes were associated with complications like bleeding, shock and organ impairment. In addition to thrombocytopenia, hepatic involvement plays a significant role in bleeding. Elevated liver enzymes have got prognostic value in this study. Hence, liver enzymes are mandatory in dengue fever to look for complications and it is of prognostic value. Those patients with elevated liver enzymes should be monitored carefully than those with normal liver enzymes.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Dengue Fever, Serum Aminotransferases, Thrombocytopaenia, Bleeding.
Subjects: MEDICAL > General Medicine
Depositing User: ADMIN TNMGRMU
Date Deposited: 13 Jun 2017 14:05
Last Modified: 02 Feb 2018 02:28

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