Evaluation of liver function tests in the paediatric patient
Víctor Fernández Ventureira1, Ignacio Ros Arnal1, Gerardo Rodríguez Martínez2
1Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Universitario Miguel Servet, Zaragoza, Spain.
Insights
Many children with elevated alanine aminotransferase (ALT) enzyme levels lack proper monitoring, leading to missed opportunities for diagnosing liver disease. Prompt investigation of unexplained hypertransaminasaemia in children is crucial for timely intervention.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Clinical Diagnostics
Background:
- Elevated liver function tests, such as alanine aminotransferase (ALT), can indicate underlying disease in asymptomatic patients.
- Non-specific changes in liver tests necessitate careful evaluation to rule out serious conditions.
Purpose of the Study:
- To assess the follow-up and diagnostic yield of unexplained elevated ALT levels in children.
- To determine the proportion of children with abnormal liver tests who are adequately monitored and diagnosed with liver disease.
Main Methods:
- Retrospective cohort study of pediatric patients with elevated ALT.
- Analysis of laboratory records from a central hospital laboratory over a 6-month period.
- Exclusion of patients with pre-existing liver abnormalities or comorbidities.
Main Results:
- Out of 403 patients with elevated ALT, 236 formed the final study sample after exclusions.
- Only 22.6% of patients initially had a diagnosed condition explaining ALT elevation, with suboptimal follow-up (33.3%).
- In the final sample of 236, adequate follow-up was documented in only 29%, leading to a liver disease diagnosis in 13% (9 patients).
Conclusions:
- A significant number of children with unexplained elevated ALT in the studied area receive inadequate monitoring.
- This lack of follow-up results in missed opportunities for early diagnosis and treatment of pediatric liver disease.
- Comprehensive investigation of all children presenting with unexplained hypertransaminasaemia is recommended.
Introduction:
Although changes in liver function tests can be non-specific in numerous clinical conditions, they can be the first sign of a potentially serious disease in an asymptomatic patient.
Material And Methods:
Retrospective cohort study, performed by reviewing the records of children of a reference hospital central laboratory with alanine aminotransferase enzyme (ALT) elevation during a 6-month aleatory period.
Results:
572 blood tests with serum ALT elevation corresponding to 403 patients have been assessed during the period studied. 98 patients were excluded for presenting abnormal liver test before the study period of comorbidity that could produce ALT elevation. The remaining 305 patients, 22.6% were diagnosed with a medical condition during the first blood test that explained the ALT elevation, although only 33.3% of them were followed up until verifying their normalisation. Final study sample consists of 236 patients with abnormal liver test without apparent liver disease. Adequate follow-up was found only in 29% of them. From this group, 9 patients (13%) were diagnosed with liver disease. The rest of the samples were not properly monitored. In patients with higher serum ALT levels, follow-up was early and more appropriate.
Conclusions:
In our area, most children without apparent liver disease are no properly monitored. Therefore, an opportunity to diagnosis and treat a potential liver disease was lost in a great number of children. All children with unexplained hypertransaminasaemia must be studied.
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