# Integrating Ultrasonographic and Biochemical Markers to Assess Dengue Severity in Critical Care: A Retrospective Study

## TL;DR

This study shows that elevated liver enzymes and thickened gallbladder walls can help identify severe dengue cases in ICU patients.

## Contribution

The study introduces gallbladder wall thickness as a novel clinical marker for predicting severe dengue outcomes.

## Key findings

- Severe dengue patients had significantly higher transaminase levels than those with warning signs.
- Gallbladder wall thickness >5 mm was more common in severe dengue and linked to higher ICU interventions and mortality.
- GBWT and transaminitis are cost-effective markers for early risk stratification in dengue patients.

## Abstract

Background and aims

Dengue fever can progress to severe disease with hepatic dysfunction and multiorgan involvement. Early identification of markers is essential for timely intervention. This study evaluated transaminitis and gallbladder wall thickness (GBWT) as markers of severe dengue in critically ill patients.

Materials and methods

A retrospective observational study was conducted on 120 serologically confirmed dengue patients admitted to a tertiary ICU between July and November 2023. Patients were categorized according to the WHO 2009 criteria into dengue with warning signs and severe dengue. Serum transaminase levels and GBWT (>5 mm) were recorded, and their associations with ICU stay, mechanical ventilation, dialysis, and 28-day mortality were analyzed.

Results

Severe dengue cases demonstrated significantly elevated serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase levels compared with patients presenting with warning signs (p < 0.001). GBWT >5 mm was observed in 75.93% of severe dengue cases versus 54.55% of warning-sign cases (p = 0.015). GBWT >5 mm was significantly associated with an increased need for mechanical ventilation (33.77% vs. 9.30%, p = 0.04), dialysis (23.38% vs. 6.98%, p = 0.025), and higher mortality (25.97% vs. 4.65%, p = 0.003).

Conclusion

Transaminitis and increased GBWT are simple, cost-effective, and clinically meaningful markers of severe dengue in critically ill patients. Early recognition of these parameters can support timely risk stratification and help guide appropriate ICU management strategies.