Which is more important in dengue, SGPT (Serum Glutamic-Pyruvic Transaminase) or SGOT (Serum Glutamic-Oxaloacetic Transaminase)?

SGOT (AST) is More Important Than SGPT (ALT) in Dengue Infection

In dengue infection, SGOT (AST) elevation is more clinically significant than SGPT (ALT) as it shows higher elevation, correlates better with disease severity, and appears earlier in the disease course. 1

Liver Involvement in Dengue

Liver dysfunction is a common complication in dengue infection, with transaminase elevation occurring in up to 74.2% of patients 1. This hepatic involvement follows a specific pattern:

• SGOT (AST) elevation:

  • More frequently elevated than SGPT (ALT)
  • Found in 66.7-91.7% of dengue patients, with higher rates in severe dengue 1
  • Typically peaks around day 6-7 of illness 2
  • Shows stronger correlation with disease severity

• SGPT (ALT) elevation:

  • Less frequently elevated (42.4-91.7% of patients) 1
  • Shows less dramatic elevation compared to SGOT

Clinical Significance of SGOT vs SGPT in Dengue

1. Disease Severity Correlation

SGOT levels correlate more strongly with dengue severity than SGPT:

• SGOT elevation was present in 91.7% of severe dengue cases compared to 66.7% in mild cases 1
• SGOT levels were significantly higher in patients with severe dengue on days 5 and 6 of illness 2
• SGOT shows stronger negative correlation with platelet count (a marker of disease severity) 1

2. Anomalous Pattern

A distinctive feature of dengue is that SGOT is typically higher than SGPT, which differs from the pattern seen in most viral hepatitis 3. This anomalous pattern can help differentiate dengue from other viral infections early in the disease course.

3. Bleeding Risk

Patients with elevated SGOT (93.8%) had a higher incidence of bleeding manifestations compared to those with elevated SGPT (81.2%) 1, making SGOT a more sensitive marker for this serious complication.

Monitoring Recommendations

When evaluating a patient with suspected dengue:

1. Timing of testing:

   • Perform liver function tests including both transaminases
   • Remember that peak elevation typically occurs around day 6-7 of illness 2
   • Tests done earlier may not reflect the full extent of liver involvement

2. Interpretation:

   • SGOT > SGPT pattern suggests dengue infection 3
   • SGOT levels ≥ 1000 IU/L may indicate severe liver involvement, even in the absence of plasma leakage 2

3. Other laboratory parameters to monitor:

   • Platelet count (negatively correlates with transaminase levels) 1
   • Serum albumin (lowest levels seen 24 hours before maximum fluid leakage) 2
   • GGT (also significantly elevated in severe dengue) 2

Clinical Application

While both transaminases should be monitored in dengue patients, SGOT deserves particular attention as:

• It rises earlier and more dramatically
• Shows stronger correlation with disease severity
• Better predicts complications like bleeding
• The SGOT > SGPT pattern helps differentiate dengue from other viral hepatitis

Limitations and Caveats

• Neither transaminase alone has sufficient sensitivity and specificity to predict severe disease 4
• Different dengue serotypes may cause varying patterns of liver involvement 4
• Liver function tests should be interpreted alongside other clinical and laboratory parameters
• Patients with pre-existing liver disease may show different patterns of enzyme elevation

In conclusion, while monitoring both transaminases is important in dengue management, SGOT (AST) provides more valuable clinical information regarding disease severity and progression than SGPT (ALT).