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Abstract
Background: Dengue fever represents an escalating public health burden in Pakistan, with national case counts exceeding 20,000 in 2024 and Islamabad consistently reporting substantial annual epidemic activity. Hepatic dysfunction, marked by elevation of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), is among the most clinically significant systemic complications of dengue infection and can progress to acute liver failure in severe presentations.
Objective: This study compared the prevalence, severity, and pattern of hepatic dysfunction between two consecutive dengue epidemic seasons in Islamabad, Pakistan, and determined whether hepatic involvement changed significantly between 2024 and 2025.
Methods: A retrospective comparative cohort design was used, incorporating 224 NS1-positive dengue patients (112 per year) from Islamabad. Age, gender, NS1 antigen value, ALT, and AST were recorded for each patient. Data were analyzed in SPSS using descriptive statistics, the Shapiro-Wilk test, the Independent Samples t-test, the Mann-Whitney U test, the chi-square test, Fisher's exact test, and Pearson correlation, with p < .05 considered statistically significant. Ethical approval was granted by the Health Sciences/Technology Ethics Review Committee of National Skills University, Islamabad, and a waiver of informed consent was obtained for this retrospective, de-identified dataset.
Results: Mean ALT rose from 43.71 ± 22.28 U/L in 2024 to 55.55 ± 44.66 U/L in 2025 (t(222) = −2.512, p = .013, 95% CI for the mean difference [2.55, 21.13], d = 0.34), and mean AST rose from 48.99 ± 35.17 U/L to 72.31 ± 77.01 U/L (t(222) = −2.915, p = .004, 95% CI [7.55, 39.09], d = 0.39). Moderate ALT elevation increased more than fourfold (4.5% to 20.5%; χ²(2) = 13.333, p = .001, Cramér's V = 0.24), and moderate AST elevation doubled (12.5% to 25.0%; χ²(3) = 11.595, p = .009, Cramér's V = 0.23); one case of severe AST elevation (>310 U/L) occurred in 2025 versus none in 2024. Mann-Whitney U testing showed no significant difference in ALT (p = .916) or AST (p = .665) rank distributions, and median values were essentially unchanged between years, indicating that the mean-level worsening was driven by a growing subgroup of more severely affected patients rather than a shift across the whole cohort. NS1 antigen level correlated weakly with ALT (r = .186, p = .049) and AST (r = .190, p = .045) in the 2024 cohort only; this association was absent in 2025. ALT and AST were strongly correlated with one another in both years (r = .955–.970, p < .001). Gender distribution did not differ significantly between years (χ²(1) = 1.956, p = .162), although the 2025 cohort included a wider age range with more pediatric and elderly patients.
Conclusion: Hepatic dysfunction among dengue patients in Islamabad worsened significantly between 2024 and 2025, with a growing minority of patients developing moderate-to-severe transaminase elevation. These findings support incorporating routine liver function testing into standard dengue case management in Islamabad, and potentially more broadly across Pakistan, to enable earlier identification of patients at risk of hepatic complications.