Clinical relevance and discriminatory value of elevated liver aminotransferase levels for dengue severity.
BACKGROUND: Elevation of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) is prominent in acute dengue illness. The World Health Organization (WHO) 2009 dengue guidelines defined AST or ALT ≥ 1000 units/liter (U/L) as a criterion for severe dengue. We aimed to assess the clinical...
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ftdoajarticles:oai:doaj.org/article:c29bf85825e9445abed0fa88c17bedb0 2023-05-15T15:11:06+02:00 Clinical relevance and discriminatory value of elevated liver aminotransferase levels for dengue severity. Linda K Lee Victor C Gan Vernon J Lee Adriana S Tan Yee Sin Leo David C Lye 2012-01-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0001676 https://doaj.org/article/c29bf85825e9445abed0fa88c17bedb0 EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC3367991?pdf=render https://doaj.org/toc/1935-2735 1935-2735 doi:10.1371/journal.pntd.0001676 https://doaj.org/article/c29bf85825e9445abed0fa88c17bedb0 PLoS Neglected Tropical Diseases, Vol 6, Iss 6, p e1676 (2012) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2012 ftdoajarticles https://doi.org/10.1371/journal.pntd.0001676 2022-12-31T01:25:15Z BACKGROUND: Elevation of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) is prominent in acute dengue illness. The World Health Organization (WHO) 2009 dengue guidelines defined AST or ALT ≥ 1000 units/liter (U/L) as a criterion for severe dengue. We aimed to assess the clinical relevance and discriminatory value of AST or ALT for dengue hemorrhagic fever (DHF) and severe dengue. METHODOLOGY/PRINCIPAL FINDINGS: We retrospectively studied and classified polymerase chain reaction positive dengue patients from 2006 to 2008 treated at Tan Tock Seng Hospital, Singapore according to WHO 1997 and 2009 criteria for dengue severity. Of 690 dengue patients, 31% had DHF and 24% severe dengue. Elevated AST and ALT occurred in 86% and 46%, respectively. Seven had AST or ALT ≥ 1000 U/L. None had acute liver failure but one patient died. Median AST and ALT values were significantly higher with increasing dengue severity by both WHO 1997 and 2009 criteria. However, they were poorly discriminatory between non-severe and severe dengue (e.g., AST area under the receiver operating characteristic [ROC] curve=0.62; 95% confidence interval [CI]: 0.57-0.67) and between dengue fever (DF) and DHF (AST area under the ROC curve=0.56; 95% CI: 0.52-0.61). There was significant overlap in AST and ALT values among patients with dengue with or without warning signs and severe dengue, and between those with DF and DHF. CONCLUSIONS: Although aminotransferase levels increased in conjunction with dengue severity, AST or ALT values did not discriminate between DF and DHF or non-severe and severe dengue. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLoS Neglected Tropical Diseases 6 6 e1676 |
institution |
Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
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English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Linda K Lee Victor C Gan Vernon J Lee Adriana S Tan Yee Sin Leo David C Lye Clinical relevance and discriminatory value of elevated liver aminotransferase levels for dengue severity. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
BACKGROUND: Elevation of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) is prominent in acute dengue illness. The World Health Organization (WHO) 2009 dengue guidelines defined AST or ALT ≥ 1000 units/liter (U/L) as a criterion for severe dengue. We aimed to assess the clinical relevance and discriminatory value of AST or ALT for dengue hemorrhagic fever (DHF) and severe dengue. METHODOLOGY/PRINCIPAL FINDINGS: We retrospectively studied and classified polymerase chain reaction positive dengue patients from 2006 to 2008 treated at Tan Tock Seng Hospital, Singapore according to WHO 1997 and 2009 criteria for dengue severity. Of 690 dengue patients, 31% had DHF and 24% severe dengue. Elevated AST and ALT occurred in 86% and 46%, respectively. Seven had AST or ALT ≥ 1000 U/L. None had acute liver failure but one patient died. Median AST and ALT values were significantly higher with increasing dengue severity by both WHO 1997 and 2009 criteria. However, they were poorly discriminatory between non-severe and severe dengue (e.g., AST area under the receiver operating characteristic [ROC] curve=0.62; 95% confidence interval [CI]: 0.57-0.67) and between dengue fever (DF) and DHF (AST area under the ROC curve=0.56; 95% CI: 0.52-0.61). There was significant overlap in AST and ALT values among patients with dengue with or without warning signs and severe dengue, and between those with DF and DHF. CONCLUSIONS: Although aminotransferase levels increased in conjunction with dengue severity, AST or ALT values did not discriminate between DF and DHF or non-severe and severe dengue. |
format |
Article in Journal/Newspaper |
author |
Linda K Lee Victor C Gan Vernon J Lee Adriana S Tan Yee Sin Leo David C Lye |
author_facet |
Linda K Lee Victor C Gan Vernon J Lee Adriana S Tan Yee Sin Leo David C Lye |
author_sort |
Linda K Lee |
title |
Clinical relevance and discriminatory value of elevated liver aminotransferase levels for dengue severity. |
title_short |
Clinical relevance and discriminatory value of elevated liver aminotransferase levels for dengue severity. |
title_full |
Clinical relevance and discriminatory value of elevated liver aminotransferase levels for dengue severity. |
title_fullStr |
Clinical relevance and discriminatory value of elevated liver aminotransferase levels for dengue severity. |
title_full_unstemmed |
Clinical relevance and discriminatory value of elevated liver aminotransferase levels for dengue severity. |
title_sort |
clinical relevance and discriminatory value of elevated liver aminotransferase levels for dengue severity. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2012 |
url |
https://doi.org/10.1371/journal.pntd.0001676 https://doaj.org/article/c29bf85825e9445abed0fa88c17bedb0 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 6, Iss 6, p e1676 (2012) |
op_relation |
http://europepmc.org/articles/PMC3367991?pdf=render https://doaj.org/toc/1935-2735 1935-2735 doi:10.1371/journal.pntd.0001676 https://doaj.org/article/c29bf85825e9445abed0fa88c17bedb0 |
op_doi |
https://doi.org/10.1371/journal.pntd.0001676 |
container_title |
PLoS Neglected Tropical Diseases |
container_volume |
6 |
container_issue |
6 |
container_start_page |
e1676 |
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1766342008381636608 |