Clinical Characteristics and the Risk Factors of Hepatic Injury in 221 Children With Infectious Mononucleosis.

Chao Zhang,Guitao Li,Shu Cui,Guoshun Mao

doi:10.3389/fped.2021.809005

Abstract

Background: Infectious mononucleosis caused by Epstein-Barr Virus infection is a common acute infectious disease in children. About 40–80% of children with infectious mononucleosis have hepatic injury, and hepatic failure is one of the main causes of death in patients with fatal infectious mononucleosis. Identifying the demographics, presenting clinical characteristics and the risk factors of hepatic injury in infectious mononucleosis children are helpful to remind clinicians which patients are prone to have hepatic damage.Methods: A descriptive, cross-sectional study with a 31-month retrospective review was performed on all infectious mononucleosis children hospitalized in the pediatric department of Fuyang People's Hospital. Demographic data, presenting features, radiology imaging, clinical and laboratory parameters, and clinical outcomes of infectious mononucleosis children were collected.Results: Two-hundred twenty-one infectious mononucleosis inpatients were enrolled, and 43.9% (97/221) patients were considered to have a hepatic injury (defined as alanine amino transaminase > 40 U/L). Compared with patients without hepatic injury, hepatic injury patients were marked with a significantly higher percentage of hepatomegaly (31 vs. 49%), splenomegaly (58 vs. 81%) and palpebral edema (47 vs. 63%), higher age (3.05 ± 2.12 vs. 3.84 ± 2.44), hospitalization days (6.85 ± 2.64 vs. 8.08 ± 2.83), leukocyte (14.24 ± 5.32 vs. 18.53 ± 8.63), lymphocytes (9.48 ± 4.49 vs. 13.80 ± 7.47), the proportion of atypical lymphocytes (0.12 ± 0.07 vs. 0.15 ± 0.08) and aspartate aminotransferase (33.71 ± 10.94 vs. 107.82 ± 93.52). The results of correlation analysis and multiple linear regression analysis indicated that age (OR = 1.185; 95% CI = 1.035–1.357, p = 0.014), female (OR = 2.002, 95% CI: 0.261–0.955, p = 0.036) and splenomegaly (OR = 2.171, 95% CI: 1.018–4.628, p = 0.045) were independent risk factors of hepatic injury.Conclusions: In this study, the hepatic injury was associated with gender, age, and splenomegaly, which improved our understanding of risk factors about hepatic injury among infectious mononucleosis children.

Highlights

Infectious mononucleosis (IM) is an acute systemic disease caused by Epstein-Barr Virus (EBV) or, more rarely, cytomegalovirus (CMV)
We analyzed factors related to hepatic injury in Chinese IM children, hepatic injury was associated with gender, age, and splenomegaly, which confirm our understanding of risk factors about hepatic injury among infectious mononucleosis children
Our findings provide evidence that if a child admitted to hospital with EBV-IM is female, or older, or accompanies splenomegaly, or all three, clinicians must be vigilant for liver damage or even life-threatening liver failure caused by EBV

Summary

Introduction

Infectious mononucleosis (IM) is an acute systemic disease caused by Epstein-Barr Virus (EBV) or, more rarely, cytomegalovirus (CMV). It typically manifested as a triad of fever, angina, and lymphadenectasis, as well as varying degrees of hepatic injury [1]. Identifying the demographics, presenting characteristics, and risk factors of hepatic injury in infectious mononucleosis children for improving the prognosis of these rare cases of severe hepatic injury. Infectious mononucleosis caused by Epstein-Barr Virus infection is a common acute infectious disease in children. Identifying the demographics, presenting clinical characteristics and the risk factors of hepatic injury in infectious mononucleosis children are helpful to remind clinicians which patients are prone to have hepatic damage

Methods

Results

Conclusion