Frontiers in pediatrics · 2026
Alanine aminotransferase elevation in hospitalized children with infectious mononucleosis: independent associations with Epstein-Barr virus DNA load, age, and sex.
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Gan Songlin, Tang Yuan, Jiang Lianying, Mai Huazhuo
Аннотация
BACKGROUND: Alanine aminotransferase (ALT) elevation is common in pediatric infectious mononucleosis, but its relationship with Epstein-Barr virus (EBV) DNA load, age, and sex remains incompletely defined. We examined this association and identified independent correlates across pediatric age groups.
METHODS: In this single-center retrospective cross-sectional study, we included 365 children hospitalized with EBV-associated infectious mononucleosis who had admission EBV DNA quantification. Patients were grouped by age as <3, 3-6, and ≥6 years. Multivariable linear regression was used to evaluate the association between EBV DNA load and ALT level, while multivariable logistic regression assessed factors associated with ALT elevation. Age-stratified and interaction analyses examined whether these associations differed by age group, and sensitivity analyses tested the stability of the findings.
RESULTS: Higher log10(EBV DNA) was associated with higher ln(ALT) in the fully adjusted model [adjusted β = 0.32, 95% confidence interval (CI): 0.24-0.41; P < 0.001], corresponding to an approximately 38% higher ALT level for each 10-fold increase in EBV DNA load. In the primary logistic model, EBV DNA load, age, and sex were associated with ALT elevation. Compared with children aged <3 years, the adjusted odds ratios were 2.08 (95% CI: 1.15-3.74) for those aged 3-6 years and 5.89 (95% CI: 3.04-11.42) for those aged ≥6 years. Male sex was associated with lower odds of ALT elevation (adjusted odds ratio: 0.29, 95% CI: 0.17-0.51). The EBV DNA load-ALT association was similar across age groups and remained stable in sensitivity analyses.
CONCLUSIONS: Among hospitalized children with EBV-associated IM, higher EBV DNA load, older age, and female sex were independently associated with ALT elevation, findings that may help contextualize ALT elevation at initial evaluation.
METHODS: In this single-center retrospective cross-sectional study, we included 365 children hospitalized with EBV-associated infectious mononucleosis who had admission EBV DNA quantification. Patients were grouped by age as <3, 3-6, and ≥6 years. Multivariable linear regression was used to evaluate the association between EBV DNA load and ALT level, while multivariable logistic regression assessed factors associated with ALT elevation. Age-stratified and interaction analyses examined whether these associations differed by age group, and sensitivity analyses tested the stability of the findings.
RESULTS: Higher log10(EBV DNA) was associated with higher ln(ALT) in the fully adjusted model [adjusted β = 0.32, 95% confidence interval (CI): 0.24-0.41; P < 0.001], corresponding to an approximately 38% higher ALT level for each 10-fold increase in EBV DNA load. In the primary logistic model, EBV DNA load, age, and sex were associated with ALT elevation. Compared with children aged <3 years, the adjusted odds ratios were 2.08 (95% CI: 1.15-3.74) for those aged 3-6 years and 5.89 (95% CI: 3.04-11.42) for those aged ≥6 years. Male sex was associated with lower odds of ALT elevation (adjusted odds ratio: 0.29, 95% CI: 0.17-0.51). The EBV DNA load-ALT association was similar across age groups and remained stable in sensitivity analyses.
CONCLUSIONS: Among hospitalized children with EBV-associated IM, higher EBV DNA load, older age, and female sex were independently associated with ALT elevation, findings that may help contextualize ALT elevation at initial evaluation.