Hypertransaminasemia in hospitalized children: Insights from a national multicenter study by the Italian Society of Pediatric Gastroenterology, Hepatology, and Nutrition.

OBJECTIVES

Hypertransaminasemia is a frequent finding in hospitalized children with common pediatric illnesses, often considered a transitory phenomenon associated with systemic inflammation/injury. This study aims to assess the prevalence and causes of incidentally detected hypertransaminasemia in children admitted to general pediatric units for non-chronic liver-related illnesses.

METHODS

This is a prospective, multicenter observational study. Children with transaminase measurement at hospital admission were enrolled from June 2021 to July 2023. Inclusion criteria were: Age >30 days to 17 years; hospitalization for any clinical condition; Informed consent. Patients with a previous diagnosis of liver disease were excluded.

RESULTS

A total of 1652 patients (1 month to 17 years) were enrolled in nine Italian pediatric hospital centers. Overall, the prevalence of hypertransaminasemia was 34.4% (n = 570). The majority had mild to moderate liver enzymes elevation. Positive correlation were found between aspartate aminotransferase and creatin P-kinase (CPK), body mass index z-score and cholesterol. At discharge, 298 of the 570 re-tested transaminases: 21.4% (64/298) had persistent combined elevation, 13.8% (41/298) isolated alanine aminotransferase, and 37.6% (112/298) isolated elevation. Only 5.70% of the patients (n = 30) with elevated transaminase levels (n = 526) were eventually diagnosed with liver disease at discharge, whereas the majority of patients (19.9%, n = 105) received a diagnosis of pneumonia/bronchitis/upper respiratory tract infection, followed by unspecified infections (10.6%, n = 56).

CONCLUSIONS

Hypertransaminasemia is common in children admitted to the general pediatric units, affecting approximately 35% of patients. Liver-related discharge diagnoses were uncommon among children with elevated transaminases (5.70%), whereas most cases occurred in the setting of acute non-hepatic illnesses. Children with persistently elevated transaminases at discharge should be followed to rule out chronic liver disease.