Etiological Spectrum of Children Presenting With Raised Liver Transaminases and Their Outcome in a Tertiary Care Pediatric Facility at Navi Mumbai, India

Abstract

Etiology and outcome of children presenting with raised liver transaminases and to analyze liver functions with various etiologies. A prospective analytical study. Setting: Tertiary care centre. Children from 3 months to 18 years of age who presented with symptoms and clinical signs suggestive of liver disease or any one showing raised transaminases level in their laboratory report were included in the study from December 2013 to July 2014. Relevant demographic data, history and detail clinical examination were recorded to arrive at a presumptive clinical diagnosis. Investigations were further done in accordance with the presentation and clinical setting of the case to arrive at a final diagnosis. Out of the 1020 children screened, total of 203 cases were enrolled with mean age at presentation of 71 months and 60% were male. The causes of hypertransaminasemia were infectious in 97 (48%) [viral 33 and non-viral 64], metabolic in 11 (5%), structural defects /surgical conditions in 20 (10%), hemodynamic abnormality in 14 (7%), obesity/NASH in 11 (5%), toxic in 23 (12%), immunological in 13 (6%) and miscellaneous in 14 (7%). Mode of presentation is acute hepatitis, acute liver failure, acute on chronic liver disease and chronic liver disease in 150 (73%), 28 (14%), 7 (4%) and 18 (9%) respectively. Mean ALT/AST was significantly (P = .004/.001) higher in metabolic and infectious causes as compared to other causes. Mean total bilirubin was significantly (P ≤ .001) raised in structural defects and metabolic conditions (6.3 mg/dl) as compared to other (2.7 mg/dl). Twenty five out of 78 patients followed for more than 3 month had showed persistent hypertransaminasemia (Wilson's disease 5, Glycogen storage disease 4, galactosemia 2, Tyrosinemaia 1, acute viral hepatitis-B 4, drug induced hepatitis 5, Duschene’s Muscular Dystrophy 2 and thalassemia 2). The study underlines existence of a considerably large group of conditions apart from the conventional impression of viral hepatitis causing hypertransaminasemia.