From the Research
Elevated ALT and AST levels in dengue fever indicate liver involvement, which is a common complication of the infection, and significantly elevated levels (>10 times normal) may signal severe dengue or development of acute liver failure, requiring immediate medical attention. These liver enzymes typically rise during the acute phase of dengue fever as the virus directly infects liver cells and causes inflammation. The elevation is usually moderate (2-3 times normal values) but can occasionally be more severe. This liver involvement is generally transient and self-limiting, with enzyme levels returning to normal during recovery without specific treatment.
Key Points to Consider
- Patients with pre-existing liver disease are at higher risk for more severe liver involvement 1.
- No specific medications are needed to treat the elevated enzymes themselves, but supportive care with adequate hydration and monitoring is essential.
- Acetaminophen can be used for fever management at standard doses (not exceeding 3g daily), while NSAIDs should be avoided due to bleeding risk 2.
- Regular monitoring of liver enzymes is recommended until they normalize, which typically occurs within 1-3 weeks after recovery.
- The AST2/ALT composite index may be used as a marker for identification of severe dengue based on admission AST and ALT, with two choices of cutoff values, 402 and 653 3.
Clinical Implications
- Elevated AST and ALT levels are associated with increased IL-2 and predict severe outcomes in clinically apparent dengue virus infection 2.
- High-level ALT during the febrile stage is associated with shock 4.
- AST is most likely of liver origin, and CK does not provide additional value in identifying severe dengue 3.