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Liver involvement in children with SARS-COV-2 infection: Two distinct clinical phenotypes caused by the same virus

Adriana Perez1, Amanda Cantor2, Bryan Rudolph1

  • 1Division of Gastroenterology, Hepatology and Nutrition, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY, USA.

Liver International : Official Journal of the International Association for the Study of the Liver
|April 7, 2021
PubMed

Insights

Elevated liver enzymes (E-ALT) in children with SARS-CoV-2 infection indicate more severe disease, particularly in multisystem inflammatory syndrome (MIS-C). E-ALT was more common in MIS-C than COVID-19 but not linked to mortality.

Area of Science:

  • Pediatric Hepatology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection can cause acute liver injury (ALI), associated with poor outcomes in adults.
  • Understanding SARS-CoV-2 related liver injury in children is crucial for managing different disease manifestations.

Purpose of the Study:

  • To compare the characteristics of children with elevated alanine aminotransferase (E-ALT) in two SARS-CoV-2 manifestations: multisystem inflammatory syndrome in children (MIS-C) and COVID-19.
  • To identify factors associated with E-ALT in pediatric COVID-19 and MIS-C cases.

Main Methods:

  • Retrospective study of 291 patients ≤21 years old with SARS-CoV-2 PCR positivity.
  • E-ALT defined as ALT > 40 U/L. Bivariate and multivariable logistic regression analyses were performed.
  • Comparison of E-ALT prevalence and associated factors between COVID-19 and MIS-C cohorts.

Main Results:

  • 36% of patients had E-ALT (31% with COVID-19, 51% with MIS-C).
  • In COVID-19, E-ALT associated with obesity, immunocompromise, and higher C-reactive protein.
  • In MIS-C, E-ALT associated with male gender and Black race. Children with E-ALT in both groups had more severe disease, longer hospitalizations, and ICU stays. MIS-C carried a 2.3-fold increased risk of E-ALT compared to COVID-19.

Conclusions:

  • Elevated liver enzymes in SARS-CoV-2 infected children present as transaminitis without hepatic synthetic dysfunction.
  • Children with E-ALT, regardless of COVID-19 or MIS-C, experienced more severe clinical outcomes.
  • MIS-C demonstrated a higher prevalence of E-ALT compared to COVID-19 in pediatric patients.
Abstract

Keywords:
COVID-19 ALI in childrenacute liver failureacute liver injury and MISCelevated ALTliver involvement in SARS-CoV2

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