OBJECTIVES: AST and ALT often rise in dengue patients up to five-fold; they usually peak in the second week of illness. This study aims to determin the significance of elevated AST,ALT; AST:ALT ratio among pediatric patients with Dengue Shock Syndrome (DSS).

METHODS: From October 2008 to October 2009, 57 pediatric patients, who met the criteria for DSS, were admitted in the ICU. AST, ALT and AST:ALT determinations were done open admission.

RESULTS: The differences in the elevation of AST, ALT and AST:ALT in relation to age and sex of patients were not statistically significant (p-value= >0.05). A significance was noted in the ALT elevation when correlated to BMI (p-value 0.04) as opposed to only a marginal significance with AST. The more obese the patient the higher the increase in the level of serum transaminases. There was only marginally significant difference in the elevation AST:ALT ratio according to BMI (p-values 0.06 and 0.09 respectivelty). A 4-fold increase in both AST and ALT were not significantly associated with the presence or absence of hepatomegaly (p-value = > 0.05). However, there was a significant difference noted in the AST:ALT ratio according to outcome -- those who died had an elevated mean ratio than those who survived (p value= 0.01). On the other hand, there was a marginally significant difference in the AST elevation according to outcome (p value = 0.08). A four-fold increase in both AST and ALT were significantly associated with mortality (p- values 0.004 and 0.03 respectively).

CONCLUSION: AST and ALT elevation of >4-fold may prognosticate the outcome of patients with DSS. Further investigation is required.