Etiological evaluation of the elevated transaminases in children

Aslıhan Sanrı; Ceyda Tuna Kırsaçlıoğlu; Emre Sanrı; Tülin Revide Şaylı

doi:10.7197/cmj.vi.593477

EN

Etiological evaluation of the elevated transaminases in children

Abstract

Objective: We aimed to determine the etiology of hypertransaminasemia in children, demonstrate the differences according to the age and evaluate course of transaminases.
Method: We retrospectively analyzed the medical records of children who presented with elevated transaminase levels for at least 2 months, aged between 3 months and 18 years, for demographic features, laboratory, radiologic and histopathological findings.
Results: Among total 292 children, 194 (66.4%) were male and 98 (33.6%) were female. The mean age was 6.5±5.4 years. The 45.9% of the children had no complaints at presentation. Majority of the patients had mildly elevated transaminases (81.6%). The most common etiology was non-alcoholic fatty liver disease (NAFLD) (25.7%). The NAFLD was more prevelant in patients older than 5 years-old (p<0.001). The second cause was infectious diseases (97.8% were viral infections) and more prevelant in patients younger than 2 years-old (p=0.043). In 34.1 % of the children, no overt cause of hypertransaminasemia was identified. The patients with unidentified etiology were significantly younger, but had higher mean aspartate aminotransferase (AST) levels than the patients in whom the etiology was identified (p= <0.0001, p=0.008 respectively). The normalization of transaminases was seen in 40.4% of the patients at mean 5.4±4.4 months. The shortest normalization time was observed in drug related liver injury (DILI) among all other etiologies (p=0.015).
Conclusions: The most common cause of hypertransaminasemia in childhood were NAFLD and viral infections, which varies by age. A stepwise approachment to hypertransaminasemia leads to early diagnosis.

Keywords

Hypertransaminasemia,children,infections,obesity

References

1. Vajro PM, Maddoluno S, Veropalumbo C. Persistent hypertransaminasemia in asymptomatic children: A stepwise approach. World J Gastroenterol 2013; 14; 19: 2740–2751.
2. Rook M, Rosenthal P. Caring for adults with pediatric liver disease. Curr Gastroenterol Rep 2009; 11: 83-89 [PMID: 19166664 DOI: 10.1007/s11894-009-0013-7].
3. Hyun HJ, Shim JJ, Kim JW, Lee JS, Lee CK, Jang JY, et al. The prevalence of elevated alanine transaminase and its possible causes in the general Korean population. J Clin Gastroenterol 2014; 48(6):534-539. doi: 10.1097/MCG.0b013e3182a474d3.
4. Çeltik C, Erbaş H, Kurşun ÖS, Bostancıoğlu M, İnan M, Öner N et al. The Reasons of Elevated Serum Transaminases in Childhood [Article in Turkish]. Turk J Biochem 2008; 33(4):175–181.
5. Iorio R, Sepe A, Giannattasio A, Cirillo F, Vegnente A. Hypertransaminasemia in childhood as a marker of genetic liver disorders. J Gastroenterol 2005; 40: 820-826.6. Serdaroglu F, Koca T, Dereci S, Akcam M. The etiology of hypertransaminasemia in Turkish children.. Bosn J Basic Med Sci. 2016;16(2):151-156.
7. Bugeac N, Pacht A, Mandel H, Iancu T, Tamir A, Srugo I, et al. The significance of isolated elevation of serum aminotransferases in infants and young children. Arch Dis Child 2007; 92(12):1109-1112. http://dx.doi.org/10.1136/adc.2007.121194.
8. Ahmar Shamim, Nimain C. Mohanty. Etiological Spectrum of Children Presenting With Raised Liver Transaminases and Their Outcome in a Tertiary Care Pediatric Facility at Navi Mumbai, India. Clinical Gastroenterology and Hepatology 2015; Vol. 13, No. 7.
9. Krebs NF, Himes JH, Jacobson D, Nicklas TA, Guilday P, et al. (2007) Assessment of child and adolescent overweight and obesity. Pediatrics 120: S193–S228.

10. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320: 1240–1243.
11. Fishbein MH, Miner M, Mogren C, Chalekson J. The spectrum of fatty liver in obese children and the rela¬tionship of serum aminotransferases to severity of ste¬atosis. J Pediatr Gastroenterol Nutr 2003; 36(1):54–61. http://dx.doi.org/10.1097/00005176-200301000-00012.
12. Tajiri K, Shimizu Y. Practical guidelines for diagnosis and early man¬agement of drug-induced liver injury. World J Gastroenterol 2008; 14(44):6774-6785. http://dx.doi.org/10.3748/wjg.14.6774.
13. Gilbert-Barnes E, Barness LA, Farrell PM. Clinical Use of Pediatric Diagnostic Tests. 6th ed. Philadephia. Lippincott Williams, Wilkins. 2003; 20-56.
14. Schwimmer JB, Deutsch R, Kahen T, Lavine JE, Stanley C. Prevalence of fatty liver in children and adolsecents. Pediatr 2006; 118: 1388-1393.
15. Franzese A, Vajro P, Argenziano A, Rubino A, Brunetti F, Saviano MC, et al. Liver involvement in obese children. Ultrasonography and liver enzyme levels at diagnosis and during follow-up in an Italian population. Dig Dis Sci. 1997;42:1428 –1432.
16. Tazawa Y, Noguchi H, Nishinomiya F, Takada G. Serum alanine aminotransferase activity in obese children. Acta Pediatr. 1997;86:238 –241.
17. Strauss RS, Barlow SE, Dietz WH. Prevalence of abnormal serum aminotransferase values in overweight and obese adolescents. J Pediatr. 2000;136:727–733. 18. Chan DF, Li AM, Chu WC, Chan MH, Wong EM, Liu EK, et.al. Hepatic steatosis in obese Chinese children. Int J Obes Relat Metab Disord. 2004;28:1257– 1263.
19. Rafeey M, Mortazavi F, Mogaddasi F, Robabeh G, Ghaffari S, Hasani A. Fatty liver in children. Ther Clin Risk Manag 2009; 5: 371–374.
20. Purcell M, Flores YN, Zhang ZF, Denova-Gutiérrez E, Salmeron J. Prevalence and predictors of alanine aminotransferase elevation among normal weight, overweight and obese youth in Mexico. J Dig Dis 2013; 14(9):491-499. http://dx.doi.org/10.1111/1751-2980.12072.
21. Yap JYK, Connor OC, Mager DR, Taylor G, Roberts EA. Diagnostic challenges of NAFLD in children of normal weight. Hepatol and Gastroenterol 2011; 35: 500-505.
22. Paulina Cybulska, Andy Ni, Carolina Jimenez-Rivera. Viral Hepatitis: Retrospective Review in a Canadian Pediatric Hospital. ISRN Pediatrics Volume 2011, Article ID 182964, 4 pages doi:10.5402/2011/182964.
23. Larrey D. Drug induced liver disease. J Hepatol 2000; 32: 77-78.
24. Bjornsson E, Olsson R. Outcome and prognostic markers in severe drug induced liver disease. Hepatol 2005; 42: 481-489.
25. Pandit A, Sachdeva T, Bafna P. Drug-Induced Hepatotoxicity: A Review. JAPS 2012; 02: 233-243.
26. Chalasani N, Fontana RJ, Bonkovsky HL, Watkins PB, Davern T, Serrano J, et al. Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. Gastroenterology. 2008;135:1924–1934. 1934 e1921–1924.
27. Burra P, Lecturer S. Liver abnormalities and endocrine diseases. Clin Gastroenterol 2013; 27: 553-563.
28. García Romero R, Martín de Carpi J, Bernal Cuartas C, Pinillos Pisón S, Varea Calderón V. Autoimine hepatitis in pediatric patients. Rev Esp Enferm Dig 2007; 99 255-258.
29. Clark J, Brancati F, Diehl A. The prevelance and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol 2003; 98: 960-967.

Details

Primary Language

English

Subjects

Health Care Administration

Journal Section

Research Article

Authors

Aslıhan Sanrı ^*
0000-0003-1898-0898
Türkiye

Ceyda Tuna Kırsaçlıoğlu
0000-0002-3551-7267
Türkiye

Emre Sanrı
0000-0003-2192-3229
Türkiye

Tülin Revide Şaylı
0000-0003-3548-5477
Türkiye

Publication Date

May 20, 2020

Submission Date

July 17, 2019

Acceptance Date

April 29, 2020

Published in Issue

Year 2020 Volume: 42 Number: 1

DOI

https://doi.org/10.7197/cmj.vi.593477

IZ

https://izlik.org/JA68UY98JJ

Cite

RIS / Bibtex

AMA

1.Sanrı A, Tuna Kırsaçlıoğlu C, Sanrı E, Şaylı TR. Etiological evaluation of the elevated transaminases in children. CMJ. 2020;42(1):56-64. doi:10.7197/cmj.vi.593477

Cited By

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Etiological and clinical characteristics of childhood hypertransaminasemia: a retrospective study

Turkish Journal of Clinics and Laboratory

https://doi.org/10.18663/tjcl.1832567

Öz

Etiological evaluation of the elevated transaminases in children

Abstract

Keywords

References

Details

Primary Language

Subjects

Journal Section

Authors

Publication Date

Submission Date

Acceptance Date

Published in Issue

DOI

IZ

Cite

Cited By

Causes of hypertransaminasemia in children, single-center experience

Etiological and clinical characteristics of childhood hypertransaminasemia: a retrospective study