Angelo Di Giorgio, Giusy Ranucci, Pietro Aliberti, Carmela Pia Senatore, Camilla Calì, Angelo Mazza, Francesca Sbravati, Patrizia Alvisi, Maurizio Giuseppe Fuoti, Ilaria Rochira, Antonio Marseglia, Maria Rosa Pastore, Annalisa Madeo, Alessandro La Rosa, Federica Ferrari, Fortunata Sabrina Civitelli, Valentina Maffini, Icilio Dodi, Serena Della Femina, Andrea Colangelo, Lorenzo D'Antiga, Claudia Mandato
Hypertransaminasemia is common in children admitted to the general pediatric units, affecting approximately 35% of patients. Liver-related discharge diagnoses were uncommon among children with elevated transaminases (5.70%), whereas most cases occurred in the setting of acute non-hepatic illnesses. Children with persistently elevated transaminases at discharge should be followed to rule out chronic liver disease.
OBJECTIVES: Hypertransaminasemia is a frequent finding in hospitalized children with common pediatric illnesses, often considered a transitory phenomenon associated with systemic inflammation/injury. This study aims to assess the prevalence and causes of incidentally detected hypertransaminasemia in children admitted to general pediatric units for non-chronic liver-related illnesses.
METHODS: This is a prospective, multicenter observational study. Children with transaminase measurement at hospital admission were enrolled from June 2021 to July 2023. Inclusion criteria were: Age >30 days to 17 years; hospitalization for any clinical condition; Informed consent. Patients with a previous diagnosis of liver disease were excluded.
RESULTS: A total of 1652 patients (1 month to 17 years) were enrolled in nine Italian Pediatric hospital centers. Overall, the prevalence of hypertransaminasemia was 34.4% (n = 570). The majority had mild to moderate liver enzymes elevation. Positive correlation were found between aspartate aminotransferase and creatin P-kinase (CPK), body mass index z-score and cholesterol. At discharge, 298 of the 570 re-tested transaminases: 21.4% (64/298) had persistent combined elevation, 13.8% (41/298) isolated alanine aminotransferase, and 37.6% (112/298) isolated elevation. Only 5.70% of the patients (n = 30) with elevated transaminase levels (n = 526) were eventually diagnosed with liver disease at discharge, whereas the majority of patients (19.9%, n = 105) received a diagnosis of pneumonia/bronchitis/upper respiratory tract infection, followed by unspecified infections (10.6%, n = 56).
CONCLUSIONS: Hypertransaminasemia is common in children admitted to the general pediatric units, affecting approximately 35% of patients. Liver-related discharge diagnoses were uncommon among children with elevated transaminases (5.70%), whereas most cases occurred in the setting of acute non-hepatic illnesses. Children with persistently elevated transaminases at discharge should be followed to rule out chronic liver disease.