Liver injury and ascites in dengue.

Sir, T original article “The study of Hepatic dysfunction in Dengue” in the issue no.7 of July 2013 vol 61 invokes the rapid response to discuss the significance of liver enzymes in dengue fever and unusual features specifically mentioned in conclusions. Normal blood test for liver function tests include: ALT, AST, ALP, albumin, total protein. bilirubin, GGT, PT. However, it must be clarified that they can be normal in patients with serious liver disease and abnormal in patients with diseases that do not affect liver. The liver carries out thousands of biochemical functions, most of which cannot be easily measured by blood tests. Laboratory tests can measure only limited number of these functions. In fact, many tests such as aminotransferases or alkaline phosphates do not measure live function at all.1 The title gives an impression that this study is only assessing hepatic dysfunction; though the parameters studied cannot to be considered as strong evidence in favour of the same. The impact of coinfect ion with h e p a t i t i s v i r u s e s o r c o n c o m i t a n t hepatotoxic drugs was not assessed in this retrospective study. The aetiology of elevated aminotransferase levels during acute dengue illness is unclear since AST is expressed in the heart, skeletal muscle, red blood cells, kidneys, brain, and liver, while ALT is secreted primarily by the liver.2-3 Because dengue infection can cause acute damage to these nonhepatic tissue types that express AST, raised aminotransferase levels may not be entirely due to severe l iver involvement. It is therefore possible that the patients with high AST levels were also more likely to be classified as severe dengue under the 2009 criteria due to Liver Injury and Ascites in Dengue