Elevation in liver enzymes are associated with increased IL-2 and may predict severe outcomes of dengue virus infection in a Sri Lankan cohort

This is an open access article under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)Background: A synergistic effect of host genetic factors, host\udimmunity and the virulence of dengue viruses (DENV) contribute\udto the pathogenesis of DENV infections. In severe DENV infections,\udthe hepatic transaminase AST level increases more than the hepatic\udtransaminase ALT.\udIL-2 and TNF- are both elevated in DENV infection as a part of\udthe body’s early response to infection. The objective was to assess\udthe correlation between changes in IL-2 and TNF- levels with\udchanges in liver enzymes in dengue patients with varying clinical\udseverity.\udMethods & Materials: A total of 67 DENV infected patients\ud(DF=24 and DHF=43) either confirmed by ELISA or RT-PCR from July\ud2011 to February 2012 from General Hospital Kandy were selected\udfor the IL-2 and TNF- evaluation using a single analyte ELISArray\ud(Qiagen, Germany). Clinical, haematological parameters and hepatic\udtransaminases (AST and ALT) were recorded on admission. Five\udmL of blood was collected from DENV suspected patients on fever\uddays 5 or less (onset of fever was considered as day 1).\udResults: Of the patients, 47.76% (n=32) showed AST: ALT >2.\udAST: ALT mean ±SD among DF was 1.64±0.74 U/L while it was\ud3.18± 4.50 U/L for DHF/DSS patients.\udNo significant correlation was noted between AST: ALT and TNF-\ud and also with IL-2. A significant positive linear correlation was\udobserved between AST and IL-2 levels (r= 0.31 p = 0.01) and also\udbetween ALT and IL-2 levels (r= 0.27 p = 0.02). No significant correlation\udwas noted between AST and TNF- and ALT and IL-2.\udConclusion: Almost half of our study population showed AST:\udALT>2 indicating acute changes in liver function and the potential\udfor liver derangement due to DENV infection. There was a statistically\udsignificant positive correlation between the IL-2 with AST\udand ALT levels, although no correlation was noted between AST\udand ALT with TNF - . The positive correlations between elevations\udof AST and ALT with IL-2, and the association of higher levels of\udthese factors in DHF/DSS compared with DF suggest that these measurements\udmay be useful predictors for the progression of DENV\udinfection to severe DF/DHF