Clinical, Laboratory, and Imaging Characteristics of Liver Involvement in Hospitalized Children With COVID-19 in Iran
Shahnaz Armin1, Roxana Mansour Ghanaiee1, Abdollah Karimi1
1Pediatric Infections Research Center Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences Tehran Tehran Province Iran.
Insights
Pediatric COVID-19 patients frequently experience liver involvement, which is linked to poorer outcomes like increased intensive care unit admissions and mortality. Monitoring liver function is crucial for managing these children.
Area of Science:
- Pediatric Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) can affect multiple organs, including the liver, even in children.
- While pediatric COVID-19 is often milder, liver involvement is increasingly reported, yet its impact on outcomes is not fully understood.
Purpose of the Study:
- To evaluate the clinical, laboratory, and imaging characteristics of liver involvement in hospitalized pediatric patients with COVID-19.
- To determine the association between liver involvement and clinical outcomes in pediatric COVID-19 patients.
Main Methods:
- Retrospective analysis of 301 hospitalized pediatric COVID-19 patients.
- Liver involvement defined by elevated alanine aminotransferase (ALT) levels (>40 IU/L).
- Comparison of variables between groups with and without liver involvement using univariate and multivariable logistic regression.
Main Results:
- 27.9% of pediatric COVID-19 patients showed liver involvement (elevated ALT).
- Liver involvement was associated with higher rates of leukopenia, thrombocytopenia, elevated BUN, tachycardia, hypoxia, pulmonary infiltrations, shock, ICU admission, and mortality.
- Predictors of liver involvement varied by age, with elevated BUN and pulmonary infiltrations in younger children, and pre-admission antibiotic use and normal hemoglobin in older children.
Conclusions:
- Liver involvement is common in hospitalized pediatric COVID-19 patients and correlates with worse clinical outcomes.
- Higher intensive care unit admission and mortality rates were observed in pediatric COVID-19 patients with liver involvement.
- Early recognition and monitoring of hepatic dysfunction are recommended to improve management strategies for pediatric COVID-19 patients.
Background And Aims:
Coronavirus disease 2019 (COVID-19) affects multiple organs, including the liver. Although pediatric patients generally experience milder disease, liver involvement has been increasingly reported, and its impact on outcomes remains unclear. This study aimed to evaluate clinical, laboratory, and imaging characteristics of liver involvement in hospitalized children with COVID-19.
Methods:
We retrospectively analyzed 301 pediatric patients with confirmed COVID-19 admitted to Mofid Children's Hospital, Tehran, Iran, from March 2020 to July 2021 who met the inclusion criteria. Patients were divided into two groups based on liver involvement. Liver involvement was defined as an alanine aminotransferase (ALT) level > 40 IU/L. Variables were compared between groups with and without liver involvement using both univariate and multivariable logistic regression analyses. A p < 0.05 was considered statistically significant.
Results:
Elevated ALT was observed in 84 patients (27.9%). Liver involvement occurred significantly more often in children aged 10 years and older. Patients with hepatic involvement had higher rates of leukopenia, thrombocytopenia, elevated blood urea nitrogen (BUN), tachycardia, hypoxia, pulmonary infiltrations, and shock. The mean hospital stay was longer (7.27 vs. 6.07 days, p = 0.107). Intensive care unit (ICU) admission (29.7% vs. 15%; p = 0.003) and mortality (14.3% vs. 3.7%, p < 0.001) were both higher in the liver involvement group. Multivariate analysis showed that in children under 10 years of age, elevated BUN and pulmonary infiltrations independently predicted liver involvement, while in children ≥ 10 years, pre-admission antibiotic use and normal hemoglobin (Hb) were associated factors with hepatic involvement.
Conclusion:
Liver involvement is common among hospitalized pediatric COVID-19 patients and is associated with worse clinical outcomes, including higher ICU admission and mortality rates. Early recognition and monitoring of hepatic dysfunction may improve management strategies in this population.
