The Relationship between Liver Enzyme Levels and Severity of Lung Involvement in Children with COVID-19 Infection

COVID-19 can affect multiple organs, including the lungs and liver. Elevated liver enzymes are often observed in these patients, and a chest CT scan is typically used to assess the extent of lung involvement.The aim of this study was to determine the frequency of liver enzyme elevation in children infected with COVID-19 and evaluate the type and severity of lung involvement based on chest CT scan findings. Additionally, the study aimed to identify any relationship between hepatic enzyme abnormalities and the severity of lung involvement based on imaging findings.

A cross-sectional study was conducted on all patients under 18 years of age who were admitted to Hazrat Ali Asghar Children's Hospital from March 2020 to September 2022 with a confirmed COVID-19 infection by PCR test. Normal laboratory values for aspartate transaminase (AST) and alanine transaminase (ALT) were 8-33 U/L and 10-40 U/L, respectively. Mild, moderate, and severe increases in ALT were defined as 40-200 U/L, 200-800 U/L, and more than 800 U/L respectively. Similarly, mild, moderate, and severe increases in AST were defined as 33-165 U/L, 165-660 U/L, and more than 660 U/L, respectively. Continuous data between two groups were compared using an independent t-test, while comparisons across multiple groups were analyzed via one-way ANOVA. Associations between categorical variables were assessed using the Chi-square or Fisher's exact test.

The present study included 320 patients, with 186 (58.12%) male and 134 (41.88%) female cases. No cases of clinical hepatitis were observed during the study. In terms of ALT values, 264 (82.5%) patients had normal levels, while 56 (17.5%) had subclinical hepatitis. Specifically, 51 (16%)cases were classified as mild, 4 (1.2%) as moderate, and 1 (0.3%) as severe in terms of increased ALT levels. It is important to note that all patients showed improvement in AST and ALT levels during the course of treatment. A chest CT scan was performed in 192 cases, accounting for 60% of the total. Out of these, 110 patients (57.3%) had a normal CT scan, while 49 (25.5 %), 23 (12%), and 10 (5.2%) cases showed mild, moderate, and severe pulmonary involvement, respectively. Additionally, 4 (2%) cases had pleural effusion. Regarding the type of involvement, 27 (14%), 37 (19.3%), and 18 (9.4%) cases presented with typical, indeterminate, and atypical findings on the chest CT scan. No significant relationship was found between liver enzyme abnormalities and the severity of lung involvement based on imaging findings.

Liver enzyme values do not appear to predict the severity of lung involvement in pediatric COVID-19 patients.