The etiology of hypertransaminasemia in Turkish children

Abstract

The aim of this study was to investigate the causes of elevated levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in children. We analyzed the medical records for children aged 3 months to 18 years who presented to the hospital with ALT >45 IU/L and/or AST >50 IU/L, between 2012 and 2014, for various reasons, including those not related to liver disease. In total, 281 children met the study criteria. This group comprised of 125 (44.5%) females and 156 (55.5%) males. At the presentation, the most common patient complaint was fatigue (53.4%), while 15.7% of the patients reported no symptoms. The most common findings on the physical examination were jaundice and hepatomegaly. In 15% of the cases, the findings were normal. According to the diagnosis, the most common cause of the elevated transaminases were infections (34%), with hepatitis A virus (HAV) infection as the leading cause (18.9%). Drug-induced liver injury (DILI) was the cause in 18.1% of the cases and non-alcoholic fatty liver disease (NAFLD) in 11.1%. The highest transaminase levels were associated with HAV infection, while DILI and NAFLD caused only slightly elevated transaminases. Overall, our results show that the elevated transaminases in children are most often caused by infections, DILI, and NAFLD. In a majority of cases, elevated ALT and AST indicate liver disease, however, they could also be associated with conditions other than liver damage. Additionally, the elevated enzymes can be detected in completely healthy individuals.

Systematic review and meta‐analysis of algorithms used to identify drug‐induced liver injury (DILI) in health record databases

“…Studies from Asia or Australia were published in more recent years. Majority of the studies included adult populations (62%), two studies (7%) included children aged 18 years and below, eight studies (28%) included a mixed adult and children population, while age limit was not reported in one study . Apart from two prospective studies with shorter study periods, the rest of the studies were conducted retrospectively.…”

“…With respect to reporting quality, selection criteria and detection algorithm were generally well‐reported, with the exception of two studies which did not list out the specific diagnosis codes. Eleven studies did not report the expertise of adjudicators in confirming the DILI cases. Only seven studies performed well in generalizability.…”

“…Eleven studies did not report the expertise of adjudicators in confirming the DILI cases. Only seven studies performed well in generalizability. Studies which reported low scores had more selective population (eg drug‐specific or inpatient cases only).…”

Effects of Carbamazepine and Valproate on Serum Aspartate Aminotransferase, Alanine Aminotransferase and Gamma - Glutamyltransferase in Children

“…CBZ is potent inducer of AST, ALT and GGT, as well. The elevation of serum levels of AST, ALT and GGT, without any signs and symptoms of liver injury can be explained as a result of enzyme induction, without hepatic patology ( 7 ). Valproate (VPA) has very complicated biotransformation.…”

“…In asymptomatic patients, the most frequent causes of elevated transaminases were drug induced liver injuries. The elevation can be secondary to enzyme induction, without hepatic pathology ( 6 , 7 ).…”