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Liver transaminase concentrations in children with acute SARS-CoV-2 infection
Madeleine W Sumner1, Todd A Florin2, Nathan Kuppermann3
1Schulich School of Medicine and Dentistry, Western University, London, Canada.
Insights
Pediatric SARS-CoV-2 infection did not show a significant association with elevated liver enzymes (transaminases) compared to other respiratory viruses. This study found no difference in aspartate (AST) or alanine aminotransferase (ALT) levels in children with or without SARS-CoV-2.
Area of Science:
- Pediatric Infectious Diseases
- Hepatology
- Virology
Background:
- Liver injury is a potential complication of viral infections.
- The impact of SARS-CoV-2 on pediatric liver health requires further investigation.
- Comparing SARS-CoV-2 with other common respiratory viruses is crucial for understanding its specific effects.
Purpose of the Study:
- To assess the relationship between SARS-CoV-2 infection and liver injury in children.
- To compare transaminase concentrations in children tested for SARS-CoV-2 versus other respiratory viruses.
- To determine if SARS-CoV-2 is associated with elevated liver enzymes in a pediatric emergency department setting.
Main Methods:
- A comparative study involving children under 18 years tested for SARS-CoV-2 or other respiratory viruses in pediatric emergency departments.
- Multivariate linear regression analysis was used to compare serum aspartate (AST) and alanine aminotransferase (ALT) concentrations.
- Data were collected from two large pediatric research networks between March 2020 and February 2022.
Main Results:
- Of 16,892 enrolled children, 4,318 tested positive for SARS-CoV-2 and 3,932 for other respiratory viruses.
- Transaminase concentrations did not significantly differ between children with SARS-CoV-2 and those with other respiratory viruses.
- Isolated SARS-CoV-2 detection was not associated with elevated ALT or AST levels compared to a negative respiratory viral panel.
Conclusions:
- SARS-CoV-2 infection in children was not linked to increased initial transaminase concentrations compared to other respiratory viruses.
- Transaminase levels did not vary significantly between SARS-CoV-2 positive and negative children within the study cohort.
- No new-onset liver disease was reported in SARS-CoV-2 positive children during the 90-day follow-up period.
Objective:
To evaluate the relationship between SARS-CoV-2 infection and liver injury by comparing transaminase concentrations among children tested for SARS-CoV-2 and other respiratory viruses in pediatric emergency departments.
Design & Methods:
Eligible children were <18 years with suspected SARS-CoV-2, tested using molecular approaches in emergency departments between March 7, 2020, and June 15, 2021 (Pediatric Emergency Research Network), and between August 6, 2020, and February 22, 2022 (Pediatric Emergency Research Canada). We compared aspartate (AST) and alanine aminotransferase (ALT) concentrations at presentation for SARS-CoV-2 and other respiratory viruses through a multivariate linear regression model, with the natural log of serum transaminase concentrations as dependent variables.
Results:
Of 16,892 enrolled children, 2,462 (14.6%) had transaminase concentrations measured; 4318 (25.6%) were SARS-CoV-2 positive, and 3932 (23.3%) were tested for additional respiratory viruses. Among study participants who had additional respiratory virus testing performed, the most frequently identified viruses were enterovirus/rhinovirus [8.7% (343/3,932)], respiratory syncytial virus [4.6% (181/3,932)], and adenovirus [2.6% (103/3,932)]. Transaminase concentrations were elevated in 25.6% (54/211) of children with isolated SARS-CoV-2 detection and 21.6% (117/541) of those with no virus isolated; P = 0.25. In the multivariable model, isolated SARS-CoV-2 detection was not associated with elevated ALT (adjusted geometric mean ratio (IU/L): 0.96; 95%Confidence Interval (CI): 0.84, 1.08) or AST (adjusted geometric mean ratio (IU/L): 1.03; 95%CI: 0.92, 1.16) concentrations, with negative respiratory panel as the referent group. Ninety-day follow-up was completed in 82.2% (3,550/4,318) of SARS-CoV-2 positive children; no cases of new-onset liver disease were reported.
Conclusion:
Among those tested, transaminase concentrations did not vary between SARS-CoV-2-positive children and those with a negative respiratory viral panel. In multivariate analysis, SARS-CoV-2 infection was not associated with increased initial transaminase concentrations compared to other respiratory viruses.
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