Clinico-etiological profile of raised aminotransferases in hospitalized children with liver disease and correlation with their severity level

Abstract

Objective: The aim of this study was to analyze the clinico-etiological profile of raised aminotransferases in children with their severity level. Materials and Methods: We retrospectively analyzed 65 admitted children aged 1 month to 18 years with raised aminotransferases levels from January 2015 to July 2015. We divided them into three groups based on more liver specific, alanine aminotransferase (ALT) levels as mild (1-3 times of normal), moderate (3-20 times of normal), and severe if ALT ?20 times. Results: Total 65 children were retrospectively studied with a mean age of 72±52 months (range 1 month - 18 years), and male: Female ratio of 1.5/1. These patients were divided into three groups on the basis of their maximum ALT levels. Average levels of deranged ALT (mean±standard deviation) in mild, moderate, and severe groups were 78.8±27, 289±153, and 1938±861 IU/L, respectively. Out of 65 children, the clinical presentation was acute hepatitis in 35 (53%), acute liver failure in 15 (23%), acute on chronic liver failure in 7, and chronic liver disease in 8 patients. The etiologies were acute infective hepatitis in 41% (27) followed by metabolic in 15% (10), extra hepatic obstruction (7), autoimmune hepatitis (5), ischemic causes (7), neonatal hepatitis (2), hemophagocytic lymphohistiocytosis (HLH) (2), drug induced (2), cryptogenic (2), and diabetic ketoacidosis (1). Mild elevation of aminotransferases (n=17) was most commonly seen in metabolic liver disease (35%) followed by biliary tract obstruction (28%). Moderate elevation of aminotransferases levels (n=24) was seen in acute infective (29%) followed by metabolic liver disease (16%). In patients with severe elevations (n=24), the most common etiological diagnosis was acute infective hepatitis in (70%) followed by ischemic hepatitis (20%). The most common cause of acute infective hepatitis was acute viral hepatitis A. Conclusion: On the correlation of raised ALT with etiology, we suggest that severity grading of deranged aminotransferases can guide toward etiological diagnosis and narrow down the specific investigation required. Thus, it may help in early diagnosis and cost-effective management.