A Multicenter Study of Real-world Practice for Management of Abnormal Liver Function Tests in Children with Acute
Yoon Lee1, Dae Yong Yi2, Yoo Min Lee3
1Department of Pediatrics, Korea University Medical Center Anam Hospital, Seoul, Korea.
Insights
Abnormal liver function tests (LFTs) are common in young children with infections, particularly respiratory ones. Recovery depends on age and infection history, with variations in practice observed among physicians.
Area of Science:
- Pediatric Infectious Diseases
- Hepatology
- Clinical Practice Research
Background:
- Abnormal liver function tests (LFTs) are frequently observed in pediatric patients diagnosed with acute infectious diseases.
- Limited studies and a lack of definitive clinical guidelines exist for managing these cases.
- This study investigates the causes and contributing factors of prolonged liver enzyme elevation in children.
Purpose of the Study:
- To identify the causes and factors associated with prolonged liver enzyme elevation in pediatric patients with acute infectious diseases.
- To analyze real-world clinical practices in Korea regarding the management of elevated liver enzymes in this population.
- To understand the relationship between patient characteristics, infection types, and liver enzyme recovery.
Main Methods:
- A retrospective study involving 613 pediatric patients (<18 years) with elevated alanine aminotransferase (ALT) levels due to acute infections across six Korean tertiary hospitals in 2018.
- Infections were categorized into six groups: respiratory, gastrointestinal, urinary tract, other febrile disease, Epstein-Barr virus, and cytomegalovirus.
- Data collected included physician specialty, follow-up duration, loss to follow-up rates, and diagnostic investigations performed.
Main Results:
- Respiratory infections were the most common cause (45.0%), with rhinovirus being the most frequent pathogen (9.8%).
- Older age correlated with better ALT recovery, while a higher number of infection episodes was linked to poorer recovery.
- Pediatric gastroenterologists had higher follow-up rates; diagnostic tool utilization and hepatitis workup varied significantly by physician specialty and institution.
Conclusions:
- Elevated LFTs post-systemic infection are common in pediatric respiratory infections and in infants under one year old.
- Age, infection history, and initial LFT results influence ALT recovery time.
- Significant inter-physician, inter-institution, and inter-specialty variations exist in clinical practice for managing these cases.
Background:
Abnormal liver function tests (LFTs) are commonly seen in pediatric patients with acute infectious diseases. Few studies and no definite clinical guidelines for these conditions are available. The present study aimed to elucidate the causes and factors associated with prolongation of liver enzyme elevation. We also investigated actual real-world practices in Korea.
Methods:
A retrospective study was performed on all patients younger than 18 years, who visited six tertiary teaching hospitals around Korea in 2018 for acute infectious diseases and showed alanine aminotransferase (ALT) levels above 60 IU/L without other specific conditions that could cause ALT elevation. We categorized the infections that cause LFT elevation into six groups: respiratory infection, gastrointestinal infection, urinary tract infection, other febrile disease, Epstein-Barr virus infection, and cytomegalovirus infection. We collected data on the medical specialty of the attending physician who followed up the subject, follow-up duration, percentage of follow-up loss, and their investigation.
Results:
A total of 613 patients were enrolled in this study, half of whom (50.7%) were younger than 12 months. The mean initial aspartate aminotransferase and ALT values were 171.2 ± 274.1 and 194.9 ± 316.1 IU/L (range 23-2,881, 60-2,949 IU/L), respectively; however, other LFTs were within the normal range. Respiratory infection was the most common diagnosis (45.0%), and rhinovirus was the most commonly identified pathogen (9.8%). The follow-up rate was higher with pediatric gastroenterologists (90.5%) and non-gastroenterology pediatricians (76.4%) than with pediatric residents and emergency doctors. Older age was related to better ALT recovery (odds ratio [OR] of age for month = 1.003; 95% confidence interval [CI], 1.001-1.004; P = 0.004), while the number of infection episodes (OR = 0.626; 95% CI, 0.505-0.777; P < 0.001) was associated with poor ALT recovery. Abdominal sonography was the most commonly used diagnostic tool (36.9%), followed by the hepatotropic virus workup. The modalities of hepatitis workup were significantly differently applied by physicians based on their specialties and institutions.
Conclusion:
Abnormal liver function test after a systemic infection was common in respiratory infection and under the age of 1 year. Age, number of infections, and initial results of LFTs were related to ALT recovery time. Inter-physician, inter-institution, and inter-specialty variances were observed in real-world practice.
More Related Videos
08:44Separation of Immune Cell Subpopulations in Peripheral Blood Samples from Children with Infectious Mononucleosis
Published on: September 7, 2022
04:53A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition
Published on: September 20, 2019
Related Concept Videos
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:26Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow