Liver transaminase concentrations in children with acute SARS-CoV-2 infection

Madeleine W Sumner; Todd A Florin; Nathan Kuppermann; Jianling Xie; Daniel J Tancredi; Stephen B Freedman; of the Pediatric Emergency Research Network PERN, Pediatric Emergency Research Canada PERC – COVID-19 Study Teams

doi:10.1016/j.clinbiochem.2023.110588

Liver transaminase concentrations in children with acute SARS-CoV-2 infection

Clin Biochem. 2023 Aug:118:110588. doi: 10.1016/j.clinbiochem.2023.110588. Epub 2023 May 30.

Authors

Madeleine W Sumner¹, Todd A Florin², Nathan Kuppermann³, Jianling Xie⁴, Daniel J Tancredi⁵, Stephen B Freedman⁶; of the Pediatric Emergency Research Network PERN, Pediatric Emergency Research Canada PERC – COVID-19 Study Teams

Affiliations

¹ Schulich School of Medicine and Dentistry, Western University, London, Canada.
² Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
³ Departments of Emergency Medicine and Pediatrics, UC Davis School of Medicine and UC Davis Health, Sacramento, CA, USA.
⁴ Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada.
⁵ Department of Pediatrics, UC Davis School of Medicine, Sacramento, CA, USA.
⁶ Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada. Electronic address: Stephen.freedman@ahs.ca.

Abstract

Objective: To evaluate the relationship between SARS-CoV-2 infection and liver injury by comparing transaminase concentrations among children tested for SARS-CoV-2 and other respiratory viruses in pediatric emergency departments.

Design & methods: Eligible children were <18 years with suspected SARS-CoV-2, tested using molecular approaches in emergency departments between March 7, 2020, and June 15, 2021 (Pediatric Emergency Research Network), and between August 6, 2020, and February 22, 2022 (Pediatric Emergency Research Canada). We compared aspartate (AST) and alanine aminotransferase (ALT) concentrations at presentation for SARS-CoV-2 and other respiratory viruses through a multivariate linear regression model, with the natural log of serum transaminase concentrations as dependent variables.

Results: Of 16,892 enrolled children, 2,462 (14.6%) had transaminase concentrations measured; 4318 (25.6%) were SARS-CoV-2 positive, and 3932 (23.3%) were tested for additional respiratory viruses. Among study participants who had additional respiratory virus testing performed, the most frequently identified viruses were enterovirus/rhinovirus [8.7% (343/3,932)], respiratory syncytial virus [4.6% (181/3,932)], and adenovirus [2.6% (103/3,932)]. Transaminase concentrations were elevated in 25.6% (54/211) of children with isolated SARS-CoV-2 detection and 21.6% (117/541) of those with no virus isolated; P = 0.25. In the multivariable model, isolated SARS-CoV-2 detection was not associated with elevated ALT (adjusted geometric mean ratio (IU/L): 0.96; 95%Confidence Interval (CI): 0.84, 1.08) or AST (adjusted geometric mean ratio (IU/L): 1.03; 95%CI: 0.92, 1.16) concentrations, with negative respiratory panel as the referent group. Ninety-day follow-up was completed in 82.2% (3,550/4,318) of SARS-CoV-2 positive children; no cases of new-onset liver disease were reported.

Conclusion: Among those tested, transaminase concentrations did not vary between SARS-CoV-2-positive children and those with a negative respiratory viral panel. In multivariate analysis, SARS-CoV-2 infection was not associated with increased initial transaminase concentrations compared to other respiratory viruses.

Keywords: Aminotransferase; COVID-19; Hepatotoxicity; Liver transaminase; Pediatric; SARS-CoV-2.

MeSH terms

Alanine Transaminase
COVID-19*
Child
Humans
Liver Diseases*
SARS-CoV-2

Substances

Alanine Transaminase