Hepatic involvement in children with acute bronchiolitis

Hasan M Isa; Asma Z Hasan; Sara I Khalifa; Sana S Alhewaizem; Abdulrahman D Mahroofi; Fatema N Alkhan; Mohammed Al-Beltagi

doi:10.4254/wjh.v14.i10.1907

Hepatic involvement in children with acute bronchiolitis

World J Hepatol. 2022 Oct 27;14(10):1907-1919. doi: 10.4254/wjh.v14.i10.1907.

Authors

Hasan M Isa^{1

2}, Asma Z Hasan³, Sara I Khalifa¹, Sana S Alhewaizem⁴, Abdulrahman D Mahroofi⁵, Fatema N Alkhan¹, Mohammed Al-Beltagi^{6

7

8}

Affiliations

¹ Department of Pediatrics, Salmaniya Medical Complex, Manama 12, Bahrain.
² Department of Pediatrics, Arabian Gulf University, Manama 26671, Bahrain.
³ Department of Pediatrics, Sulwan Psychiatric Hospital, Manama 973, Bu Quwah, Bahrain.
⁴ Department of Pediatrics, Dream Reem Medical Center, Muharraq 50573, Bahrain.
⁵ Department of Pediatrics, King Hamad University Hospital, Muharraq 24343, Bahrain.
⁶ Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt.
⁷ Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain.
⁸ Department of Pediatrics, University Medical Center, Dr. Sulaiman Al-Habib Medical Group, Bahrain, Manama 26671, Bahrain. mbelrem@hotmail.com.

Abstract

Background: Respiratory syncytial virus (RSV) is a prevalent cause of lower respiratory tract infections. It may be associated with hepatocellular involvement, as indicated by increased liver enzymes aspartate aminotransferase and alanine transaminase (ALT).

Aim: To evaluate the rate of increased liver enzyme levels in children with acute bronchiolitis and correlate them with clinical, laboratory, and radiological variables.

Methods: The study was a retrospective review of the medical records of children who presented with acute bronchiolitis when admitted to the Pediatric Department, Salmaniya Medical Complex, the Kingdom of Bahrain, between 2019 and 2020. We collected the demographic data, the clinical presentation, the laboratory and radiological findings, and the clinical outcomes. We compared the patients with elevated liver enzymes to those with normal levels at the time of presentation and at follow-up.

Results: We included 166 (57.8%) of 287 patients with acute bronchiolitis who fulfilled the inclusion criteria. Ninety-three (56%) patients were males. The median age at presentation was 3.4 (interquartile range 1.1 to 12.4) mo. Fifty-four (28%) patients tested positive for RSV, which was confirmed in 15 of them (28%) by PCR. Laboratory findings of 161 patients tested at presentation showed high ALT levels in 14 (8.7%) patients and normal ALT in 147 (91.3%). Coagulation profiles were measured in 46 (27.7%) of 166 patients. High prothrombin time was present in 15 (32.6%), a high international normalized ratio was present in 13 (28.3%), and high activated partial thromboplastin time was present in three (6.5%). Thrombin time was elevated in nine (27.3%) of 33 patients. Five (21.7%) of 23 patients with available radiological data had hepatomegaly; one of them had findings suggestive of fatty infiltration. High ALT had a significant association with lengthy hospital stays (P < 0.05) and positive urine culture (P < 0.05). Seventy (42.2%) patients had documented follow-up with liver function tests over a median follow-up period of 10.2 (IQR, 2.4-23.3) mo. Total serum protein and serum globulin levels were normalized at the follow-up time, with a significant P value of < 0.05.

Conclusion: This study showed a low prevalence of liver function involvement in patients with acute bronchiolitis with a benign course. However, there was a rising trend in ALT during follow-up. Prolonged hospital stay and positive urine cultures were associated with elevated liver enzymes.

Keywords: Acute bronchiolitis; Children; Liver function tests; Respiratory syncytial virus.