Severe hypertransaminasaemia during the acute hepatitis of unknown origin alert of 2022

An Pediatr (Engl Ed). 2024 Dec;101(6):370-377. doi: 10.1016/j.anpede.2024.11.007. Epub 2024 Dec 5.

Abstract

Introduction: The impact of acute severe hepatitis of unknown origin in children (SHIC) subject to a medical alert in 2022 medical alert is poorly understood.

Materials and methods: Observational study of the incidence, aetiology and clinical presentation of acute hypertransaminasaemia (HTRA) with laboratory values in the severe range (ALT and/or AST ≥ 500 U/L) in paediatric patients (age 0 to 16 years) in one health care zone from 2012 to 2022, comparing the periods of the SHIC alert and the SARS-CoV2 pandemic with previous years.

Results: The incidence of severe HTRA of any cause was 195.28 per 100 000 blood tests, with an incidence of 181.38 in the SHIC alert period and 166.09 during the SARS-CoV-2 pandemic, without statistically significant differences. Hepatitis of unknown origin accounted for 7.42% of total cases and transaminase levels normalised in 126 days (SD, 99.4). During the SHIC alert period there was a nonsignificant trend towards a higher incidence, as occurred in 2012 and 2018. In this group of cases, there was a significant increase in the presence of fever, vomiting and upper respiratory symptoms and lower levels of albumin and alkaline phosphatase. One patient required a liver transplant.

Conclusions: In our setting, there was no significant increase in the incidence of severe HTRA of any aetiology or of unknown source during either the SHIC alert or the SARS-CoV2 pandemic. In the SHIC alert period, a clinical pattern emerged characterised by an increase in nonspecific infectious symptoms, so we cannot rule out a higher prevalence of an infectious agent different from the usual involved pathogens, but it did not cause a significant change in epidemiological trends.

Keywords: Acute hepatitis of unknown origin; Aetiology; Etiología; Hepatitis aguda de origen desconocido; Hipertransaminasemia; Hypertransaminasaemia; Incidence; Incidencia; Paediatrics; Pediatría.

Publication types

  • Observational Study

MeSH terms

  • Acute Disease
  • Adolescent
  • Alanine Transaminase / blood
  • Aspartate Aminotransferases / blood
  • COVID-19* / complications
  • COVID-19* / diagnosis
  • COVID-19* / epidemiology
  • Child
  • Child, Preschool
  • Female
  • Hepatitis / epidemiology
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Male
  • Severity of Illness Index
  • Spain / epidemiology

Substances

  • Alanine Transaminase
  • Aspartate Aminotransferases