ESTIMATION OF SERUM LACTATE DEHYDROGENASE LEVELS IN CHILDREN WITH DENGUE FEVER ADMITTED IN TERTIARY CARE CENTRE AT JAIPUR

Abstract

Background: Dengue fever is the most rapidly spreading arthropod-borne viral disease worldwide with children representing a particularly vulnerable population. Serum lactate dehydrogenase (LDH), a cytoplasmic enzyme released during cellular injury has been proposed as a potential prognostic biomarker in dengue. However, its systematic evaluation in the pediatric population in India remains limited. The present study aims to the Serum Lactate Dehydrogenase levels as a marker of severity in children with Dengue Fever and its association with Platelet count. Methodology: A hospital-based observational study was conducted in the Department of Pediatrics, Mahatma Gandhi Hospital, Jaipur from April 2024 to March 2026. A total of 180 children aged 1-18 years, positive for dengue by IgM/NS1 antigen, were enrolled. Patients were classified as dengue without warning signs (n=130), dengue with warning signs (n=39) and severe dengue (n=11) using WHO criteria. Serum LDH was estimated at admission using the Siemens EXL-200 fully automated analyzer. Clinical, hematological and biochemical parameters were recorded and analyzed using descriptive statistics, Student's t-test, Chi-square test and Pearson's correlation coefficient. Results: The overall mean age was 8.42 ± 4.73 years with male predominance (68.3%); demographic variables (age p=0.841, gender p=0.928, residence p=0.231) showed no significant association with severity. Fever was universal (100%). The mean serum LDH levels increased significantly with disease severity: 259.58 ± 116.46 U/L in dengue without warning signs, 564.72 ± 92.48 U/L in dengue with warning signs and 1009.91 ± 382.33 U/L in severe dengue (p=0.001). A significant negative correlation was observed between serum LDH and platelet count (r = −0.607, p=0.000). Thrombocytopenia (p=0.001), hemoconcentration (p=0.001) and elevated liver enzymes (p=0.001) were significantly associated with disease severity. Clinical warning signs including abdominal pain (p=0.001), vomiting (p=0.001), lethargy (p=0.001), tenderness (p=0.001) and bleeding (p=0.001) were significantly more prevalent in severe groups. Conclusion: Serum LDH is a reliable, cost-effective biochemical marker for predicting the severity of dengue in children. Levels exceeding 500 U/L indicate significant disease activity, while levels approaching or exceeding 1000 U/L are strongly associated with severe dengue. Early estimation of serum LDH at admission, combined with clinical warning signs and hematological parameters, can facilitate timely risk stratification and management of pediatric dengue patients.