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Causes of hypertransaminasemia in children, single-center experience

Year 2021, Volume: 6 Issue: 1, 56 - 61, 03.04.2021

Meryem Keçeli Başaran , Tuba Çiçek

https://doi.org/10.22391/fppc.787707

Abstract

Introduction: When transaminase levels (Alanine aminotransferase: ALT, Aspartate aminotransferase: AST) are high, a causal investigation is necessary. Although the etiology and frequency of hypertransaminasemia have been examined at length in the adult population, research addressing pediatric patients is far from being sufficient in number. The objective of this study is to investigate the causes the hypertransaminasemia. We think that knowing the most common causes of hypertransaminasemia in children will help primary care physicians with diagnosis and follow-up.
Methods: The patients who were admitted to the pediatric gastroenterology policlinic between 2018- 2019 with ALT> 45 IU /L and/or AST> 50 IU /L levels were the subjects of this study. They all displayed elevated liver function test (LFT) results due to various conditions including liver-related ones and others. The medical records of the patients, who were between 6 months and 18 years of age, were analyzed.
Results: Of 237 patients included in the study, 127 (54%) were male and 110 (46%) were female. The mean age of the patients was 75.40 ± 60.50 months. 5.06% of the patients had fever, 11.39% had hepatomegaly, 7.59% suffered from loss of appetite and 7.59% had abdominal pain. The obesity rate was at 9.70% while splenomegaly was detected in 2.11% of the patients. Elevation of liver enzymes was found to be related with idiopathic causes 35% (n=83), viral infections 21% (n=50), hepatosteatosis 15% (n=38), and medication 8.80% (n=21).
Conclusion: Hypertransaminasemia may be an outcome of primary diseases of the liver and it may also be aggravated due to secondary effects. NAFLD (non-alcoholic fatty liver disease, viral infections, and medication continue to be among the most common causes. NAFLD constitutes an important cause of hypertransaminemia in children.

Keywords

child liver function tests fatty liver

References

  • 1. Schwimmer JB, Dunn W, Norman GJ, Pardee PE, Middleton MS, Kerkar N, et al. SAFETY study: alanine aminotransferase cutoff values are set too high for reliable detection of pediatric chronic liver disease. Gastroenterology 2010; 138(4):1357-64 http://dx.doi.org/10.1053/j.gastro.2009.12.052.
  • 2. Park SH, Park HY, Kang JW, Park J, Shin KJ. Aminotransferase upper reference limits and the prevalence of elevated aminotransferases in the Korean adolescent population. J Pediatr Gastroenterol Nutr 2012;55(6):668-72.
  • 3. Park HK, Hwang JS, Moon JS, Lee JA, Kim DH, Lim JS. Healthy range of serum alanine aminotransferase and its predictive power for cardiovascular risk in children and adolescents. J Pediatr Gastroenterol Nutr 2013;56(6):686-91.
  • 4. Giannini EG, Testa R, Savarino V. Liver enzyme alteration: a guide for clinicians. CMAJ 2005;172(3):367-79. http://dx.doi.org/10.1503/cmaj.1040752.
  • 5. Green RM, Flamm S. AGA technical review on the evaluation of liver chemistry tests. Gastroenterology 2002; 123(4):1367-84. http://dx.doi.org/10.1053/gast.2002.36061.
  • 6. Vajro P, Maddaluno S, Veropalumba C. Persistent hypertansaminasemia in asymptomatic children: a stepwise approach. World J Gastroenterol 2013;19(18):2740-51. http://dx.doi.org/10.3748/wjg.v19.i18.2740.
  • 7. Hennes HM, Smith DS, Schneider K, Hegenbarth MA, Duma MA, Jona JZ. Elevated liver transaminase levels in children with blunt abdominal trauma: a predictor of liver injury. Pediatrics 1990; 86(1):87-90.
  • 8. Kleiner DE, Chalasani NP, Lee WM, Fontana RJ, Bonkovsky HL, Watkins PB, et al. Drug-Induced Liver Injury Network (DILIN). Hepatic histological findings in suspected drug-induced liver injury: systematic evaluation and clinical associations. Hepatology 2014; 59(2):661-70. http://dx.doi.org/10.1002/hep.26709.
  • 9. 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):534-9. http://dx.doi.org/10.1097/MCG.0b013e3182a474d3.
  • 10. Fraser A, Longnecker MP, Lawlor DA. Prevalence of elevated alanine aminotransferase among US adolescents and associated factors: NHANES 1999-04. Gastroenterology 2007; 133(6):1814-20. http://dx.doi.org/10.1053/j.gastro.2007.08.077.
  • 11. Hudson OD, Nunez M, Shaibi GQ. Ethnicity and elevated liver transaminases among newly diagnosed children with type 2 diabetes. BMC Pediatr 2012; 12:174. http://dx.doi.org/10.1186 / 1471-2431-12-174.
  • 12. Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol 1999; 31(5):929–38. http://dx.doi.org/10.1016/S0168-8278(99)80297-9.
  • 13. Baya Botti A, Pėrez-Cueto FJ, Vasquez Monllor PA, Kolsteren PW. Anthropometry of height, weight, arm, wrist, abdominal circumference and body mass index, for Bolivian adolescents 12 to 18 years Bolivian adolescent percentile values from the MESA study. Nutr Hosp 2009;24:304-11. PMID: 19721903
  • 14. Chalasani NP, Hayashi PH, Bonkovsky HL, Navarro VJ, Lee WM, FACG, et al. ACG Clinical Guideline:the diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol. http://dx.doi.org/10.1038/ajg.2014.131.
  • 15. Botros M1, Sikaris KA. The de ritis ratio: The test of time. Clin Biochem Rev, 2013;34:117-30.
  • 16. Iorio R, Sepe A, Giannattasio A, Cirillo F, Vegnente A. Hypertransaminasemia in childhood as a marker of genetic liver disorders. J Gastroenterol 2005; 40(8):820-6. https://doi.org/10.1007/s00535-005-1635-7.
  • 17. Nobili V, Reale A, Alisi A, Morino G, Trenta I, Pisani M, et al. Elevated serum ALT in children presenting to the emergency unit: Relationship with NAFLD. Dig Liver Dis 2009; 41(10):749-52. http://dx.doi.org/10.1016/j.dld.2009.02.048.
  • 18. Çeltik C, Erbaş H, Kurşun OS, Bostancioglu M, Inan M, Oner N, et al. The reasons of elevated serum transaminases in childhood [Article in Turkish]. Turk J Biochem 2008; 33(4):175–81. https://doi.org/10.7197/cmj.vi.593477.
  • 19. Gilbert-Barness E, Barness LA, Farrell PM . Clinical use of pediatric diagnostic tests, 3rd ed. Philadelphia: Lippincott, Williams & Wilkins; 2003.
  • 20. Shen G, Zhang L, Zhang YL, Hu LP, Li MH, Lu Y, et al. Study on the etiology of acute hepatitis hospitalized patients in Beijing Ditan Hospital from 2002 to 2011. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi. 2013 Aug;27(4):266-9. Chinese. PMID: 24579471.
  • 21. Leise MD, Poterucha JJ, Talwalkar JA. Drug-induced liver injury. Mayo Clin Proc. 2014 Jan;89(1):95-106. doi: 10.1016/j.mayocp.2013.09.016. PMID: 24388027.
  • 22. Serdaroglu F, Koca T, Dereci S, Akcam M. The etiology of hypertransaminasemia in Turkish children. Bosn J Basic Med Sci. 2016;16(2):151-6. http://dx.doi.org/10.17305/bjbms.2016.982.
  • 23. 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):491-9. http://dx.doi.org/10.1111/1751-2980.12072.

Çocuklarda hipertransaminazeminin nedenleri, tek merkez deneyimi

Year 2021, Volume: 6 Issue: 1, 56 - 61, 03.04.2021

Meryem Keçeli Başaran , Tuba Çiçek

https://doi.org/10.22391/fppc.787707

Abstract

Giriş: Çocuklarda transaminaz düzeyleri (Alanin amino transferaz: ALT, Aspartat aminotransferaz: AST) yüksek olduğunda etyolojiye yönelik araştırmalar yapılmalıdır. Yetişkin popülasyonda yapılan çalışmalarda hipertransaminazeminin etiyolojisi ve sıklığı ayrıntılı olarak incelenmiş olsa da, pediatrik hastaları ele alan araştırma sayısı yeterli değildir. Bu çalışmanın amacı hipertransaminazeminin nedenlerini araştırmaktır. Çocuklarda hipertransaminazeminin en yaygın nedenlerini bilmenin, birinci basamak hekimlerine tanı ve takipte yardımcı olacağını düşünüyoruz.
Yöntem: 2018-2019 yılları arasında ALT> 45 IU / L ve / veya AST> 50 IU / L düzeyleri ile pediyatrik gastroenteroloji polikliniğine başvuran hastalar incelendi. 6 ay ile 18 yaş arasındaki karaciğer fonksiyon testleri yüksek olan hastaların tıbbi kayıtları analiz edildi.
Bulgular: Çalışmaya dahil edilen 237 hastanın 127'si (%54) erkek, 110'u (%46) kadındı. Hastaların ortalama yaşı 75,40 ± 60,50 ay idi. Hastaların%5,06'sında ateş, %11,39'unda hepatomegali, %7,59'unda iştah kaybı ve %7,59'unda karın ağrısı vardı. Obezite oranı %9,70 iken, hastaların %2,11'inde splenomegali saptandı. Karaciğer enzimlerinin yükselmesi idiyopatik nedenler %35 (n = 83), viral enfeksiyonlar %21 (n = 50), hepatosteatoz %15 (n = 38) ve ilaç %8,80 (n = 21) ile ilişkili bulunmuştur.
Sonuç: Hipertransaminazemi karaciğerin primer hastalıklarının bir sonucu olabilir ve sekonder etmenler nedeniyle de şiddetlenebilir. NAFLD (non-alkolik yağlı karaciğer hastalığı), viral enfeksiyonlar ve ilaç kullanımı en yaygın nedenler arasında olmaya devam etmektedir. NAFLD, çocuklarda hipertransaminazeminin önemli bir nedenini oluşturmaktadır.

Keywords

çocuk karaciğer fonksiyon testleri yağlı karaciğer

Supporting Institution

yok

References

  • 1. Schwimmer JB, Dunn W, Norman GJ, Pardee PE, Middleton MS, Kerkar N, et al. SAFETY study: alanine aminotransferase cutoff values are set too high for reliable detection of pediatric chronic liver disease. Gastroenterology 2010; 138(4):1357-64 http://dx.doi.org/10.1053/j.gastro.2009.12.052.
  • 2. Park SH, Park HY, Kang JW, Park J, Shin KJ. Aminotransferase upper reference limits and the prevalence of elevated aminotransferases in the Korean adolescent population. J Pediatr Gastroenterol Nutr 2012;55(6):668-72.
  • 3. Park HK, Hwang JS, Moon JS, Lee JA, Kim DH, Lim JS. Healthy range of serum alanine aminotransferase and its predictive power for cardiovascular risk in children and adolescents. J Pediatr Gastroenterol Nutr 2013;56(6):686-91.
  • 4. Giannini EG, Testa R, Savarino V. Liver enzyme alteration: a guide for clinicians. CMAJ 2005;172(3):367-79. http://dx.doi.org/10.1503/cmaj.1040752.
  • 5. Green RM, Flamm S. AGA technical review on the evaluation of liver chemistry tests. Gastroenterology 2002; 123(4):1367-84. http://dx.doi.org/10.1053/gast.2002.36061.
  • 6. Vajro P, Maddaluno S, Veropalumba C. Persistent hypertansaminasemia in asymptomatic children: a stepwise approach. World J Gastroenterol 2013;19(18):2740-51. http://dx.doi.org/10.3748/wjg.v19.i18.2740.
  • 7. Hennes HM, Smith DS, Schneider K, Hegenbarth MA, Duma MA, Jona JZ. Elevated liver transaminase levels in children with blunt abdominal trauma: a predictor of liver injury. Pediatrics 1990; 86(1):87-90.
  • 8. Kleiner DE, Chalasani NP, Lee WM, Fontana RJ, Bonkovsky HL, Watkins PB, et al. Drug-Induced Liver Injury Network (DILIN). Hepatic histological findings in suspected drug-induced liver injury: systematic evaluation and clinical associations. Hepatology 2014; 59(2):661-70. http://dx.doi.org/10.1002/hep.26709.
  • 9. 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):534-9. http://dx.doi.org/10.1097/MCG.0b013e3182a474d3.
  • 10. Fraser A, Longnecker MP, Lawlor DA. Prevalence of elevated alanine aminotransferase among US adolescents and associated factors: NHANES 1999-04. Gastroenterology 2007; 133(6):1814-20. http://dx.doi.org/10.1053/j.gastro.2007.08.077.
  • 11. Hudson OD, Nunez M, Shaibi GQ. Ethnicity and elevated liver transaminases among newly diagnosed children with type 2 diabetes. BMC Pediatr 2012; 12:174. http://dx.doi.org/10.1186 / 1471-2431-12-174.
  • 12. Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol 1999; 31(5):929–38. http://dx.doi.org/10.1016/S0168-8278(99)80297-9.
  • 13. Baya Botti A, Pėrez-Cueto FJ, Vasquez Monllor PA, Kolsteren PW. Anthropometry of height, weight, arm, wrist, abdominal circumference and body mass index, for Bolivian adolescents 12 to 18 years Bolivian adolescent percentile values from the MESA study. Nutr Hosp 2009;24:304-11. PMID: 19721903
  • 14. Chalasani NP, Hayashi PH, Bonkovsky HL, Navarro VJ, Lee WM, FACG, et al. ACG Clinical Guideline:the diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol. http://dx.doi.org/10.1038/ajg.2014.131.
  • 15. Botros M1, Sikaris KA. The de ritis ratio: The test of time. Clin Biochem Rev, 2013;34:117-30.
  • 16. Iorio R, Sepe A, Giannattasio A, Cirillo F, Vegnente A. Hypertransaminasemia in childhood as a marker of genetic liver disorders. J Gastroenterol 2005; 40(8):820-6. https://doi.org/10.1007/s00535-005-1635-7.
  • 17. Nobili V, Reale A, Alisi A, Morino G, Trenta I, Pisani M, et al. Elevated serum ALT in children presenting to the emergency unit: Relationship with NAFLD. Dig Liver Dis 2009; 41(10):749-52. http://dx.doi.org/10.1016/j.dld.2009.02.048.
  • 18. Çeltik C, Erbaş H, Kurşun OS, Bostancioglu M, Inan M, Oner N, et al. The reasons of elevated serum transaminases in childhood [Article in Turkish]. Turk J Biochem 2008; 33(4):175–81. https://doi.org/10.7197/cmj.vi.593477.
  • 19. Gilbert-Barness E, Barness LA, Farrell PM . Clinical use of pediatric diagnostic tests, 3rd ed. Philadelphia: Lippincott, Williams & Wilkins; 2003.
  • 20. Shen G, Zhang L, Zhang YL, Hu LP, Li MH, Lu Y, et al. Study on the etiology of acute hepatitis hospitalized patients in Beijing Ditan Hospital from 2002 to 2011. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi. 2013 Aug;27(4):266-9. Chinese. PMID: 24579471.
  • 21. Leise MD, Poterucha JJ, Talwalkar JA. Drug-induced liver injury. Mayo Clin Proc. 2014 Jan;89(1):95-106. doi: 10.1016/j.mayocp.2013.09.016. PMID: 24388027.
  • 22. Serdaroglu F, Koca T, Dereci S, Akcam M. The etiology of hypertransaminasemia in Turkish children. Bosn J Basic Med Sci. 2016;16(2):151-6. http://dx.doi.org/10.17305/bjbms.2016.982.
  • 23. 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):491-9. http://dx.doi.org/10.1111/1751-2980.12072.
There are 23 citations in total.

Details

Primary Language English
Subjects Gastroenterology and Hepatology, Paediatrics
Journal Section Original Research
Authors

Meryem Keçeli Başaran 0000-0001-8362-8618

Tuba Çiçek 0000-0002-9058-6521

Publication Date April 3, 2021
Submission Date August 29, 2020
Acceptance Date March 19, 2021
Published in Issue Year 2021 Volume: 6 Issue: 1

Cite

APA Keçeli Başaran, M., & Çiçek, T. (2021). Causes of hypertransaminasemia in children, single-center experience. Family Practice and Palliative Care, 6(1), 56-61. https://doi.org/10.22391/fppc.787707
AMA Keçeli Başaran M, Çiçek T. Causes of hypertransaminasemia in children, single-center experience. Fam Pract Palliat Care. April 2021;6(1):56-61. doi:10.22391/fppc.787707
Chicago Keçeli Başaran, Meryem, and Tuba Çiçek. “Causes of Hypertransaminasemia in Children, Single-Center Experience”. Family Practice and Palliative Care 6, no. 1 (April 2021): 56-61. https://doi.org/10.22391/fppc.787707.
EndNote Keçeli Başaran M, Çiçek T (April 1, 2021) Causes of hypertransaminasemia in children, single-center experience. Family Practice and Palliative Care 6 1 56–61.
IEEE M. Keçeli Başaran and T. Çiçek, “Causes of hypertransaminasemia in children, single-center experience”, Fam Pract Palliat Care, vol. 6, no. 1, pp. 56–61, 2021, doi: 10.22391/fppc.787707.
ISNAD Keçeli Başaran, Meryem - Çiçek, Tuba. “Causes of Hypertransaminasemia in Children, Single-Center Experience”. Family Practice and Palliative Care 6/1 (April2021), 56-61. https://doi.org/10.22391/fppc.787707.
JAMA Keçeli Başaran M, Çiçek T. Causes of hypertransaminasemia in children, single-center experience. Fam Pract Palliat Care. 2021;6:56–61.
MLA Keçeli Başaran, Meryem and Tuba Çiçek. “Causes of Hypertransaminasemia in Children, Single-Center Experience”. Family Practice and Palliative Care, vol. 6, no. 1, 2021, pp. 56-61, doi:10.22391/fppc.787707.
Vancouver Keçeli Başaran M, Çiçek T. Causes of hypertransaminasemia in children, single-center experience. Fam Pract Palliat Care. 2021;6(1):56-61.

Family Practice and Palliative Care       ISSN 2458-8865       E-ISSN 2459-1505