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Hypertransaminasemia Is a Marker of Severity in Children Hospitalized for Influenza

Marco Poeta1,2, Cristina Moracas2,3, Elisabetta Venturini4

  • 1Pediatric Infectious Disease Unit, Department of Maternal and Child Health, University Hospital "Federico II", Naples, Italy.

Influenza and Other Respiratory Viruses
|June 24, 2026
PubMed

Insights

Elevated transaminases in children hospitalized with influenza indicate more severe illness and complications. Monitoring these enzyme levels can help identify at-risk pediatric patients early.

Area of Science:

  • Pediatric infectious diseases
  • Hepatology
  • Clinical biochemistry

Background:

  • Elevated transaminases are linked to severe influenza in adults.
  • Data on pediatric influenza and transaminase levels are limited.

Purpose of the Study:

  • To determine the prevalence and clinical significance of elevated transaminases in children hospitalized with influenza.
  • To assess the prognostic value of transaminase levels in pediatric influenza cases.

Main Methods:

  • A multicenter retrospective cohort study of 543 children hospitalized with acute viral respiratory infections.
  • Comparison of influenza cases with other viral respiratory infections.
  • Analysis of demographic, clinical, biochemical, and outcome data.
  • Assessment of associations between elevated transaminases and disease severity, complications, and intensive care unit (ICU) admission.

Main Results:

  • 23.4% of children with influenza had elevated transaminases, compared to 7.2% with other viruses (p < 0.001).
  • Influenza B was associated with higher rates of hypertransaminasemia (40%) than influenza A (20.6%).
  • Elevated transaminases correlated with longer hospital stays, ICU admission, increased oxygen needs, and intravenous fluid administration.
  • Systemic symptoms like asthenia, myalgia, and hypovolemic shock were more frequent in the elevated transaminase group.
  • Biochemical markers suggested muscular rather than hepatic origin.
  • Two deaths occurred, both in the elevated transaminase group.

Conclusions:

  • Elevated transaminases are present in approximately one-fourth of pediatric influenza hospitalizations.
  • These elevations are associated with more severe disease, systemic complications, and poorer outcomes.
  • Transaminase monitoring serves as an accessible early marker for identifying children at high risk for severe influenza.
Abstract

Keywords:
aminotransferaseschildrenhypertransaminasemiainfluenzapediatricprognostic value

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