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. 2021 Sep;41(9):2068-2075.
doi: 10.1111/liv.14887. Epub 2021 Apr 22.

Liver involvement in children with SARS-COV-2 infection: Two distinct clinical phenotypes caused by the same virus

Adriana Perez  1 , Amanda Cantor  2 , Bryan Rudolph  1 , Jonathan Miller  2 , Debora Kogan-Liberman  1 , Qi Gao  3 , Bernardo Da Silva  4 , Kara G Margolis  2 , Nadia Ovchinsky  1 , Mercedes Martinez  2
Affiliations

Liver involvement in children with SARS-COV-2 infection: Two distinct clinical phenotypes caused by the same virus

Adriana Perez et al. Liver Int. 2021 Sep.

Abstract

Background and aims: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) associated acute liver injury (ALI) has been linked to poor outcomes in adults. Here we compare characteristics in children with elevated ALT (E-ALT) in two distinct manifestations of the infection, multisystem inflammatory syndrome-children (MIS-C) and coronavirus disease 2019 (COVID-19).

Methods: This is a retrospective study of patients ≤21 years of age with positive for SARS-CoV-2 PCR. E-ALT was defined as alanine aminotransferase (ALT) > 40 U/L. Bivariate analysis and multivariable logistic regression were obtained to describe differences in children with and without E-ALT in COVID-19 and MIS-C.

Results: E-ALT was detected in 36% of the 291 patients; 31% with COVID-19, and 51% with MIS-C. E-ALT in COVID-19 was associated with obesity (P < .001), immunocompromised status (P = .04), and chronic liver disease (P = .01). In the regression models, E-ALT in COVID-19 was associated with higher c-reactive protein (OR 1.08, P = .01) after adjusting for common independent predictors. Children with E-ALT and MIS-C were more often boys (P = .001), Hispanic (P = .04), or Black (P < .001). In MIS-C, male gender (OR 5.3, P = .02) and Black race (OR 4.4, P = .04) were associated with increased odds of E-ALT. Children with E-ALT in both cohorts had significantly higher multiorgan dysfunction, longer hospitalization, and ICU stay. Children with MIS-C had 2.3-fold increased risk of E-ALT compared to COVID-19. No association was found between E-ALT and mortality.

Conclusion: E-ALT with SARS-CoV-2 presents as elevated transaminases without hepatic synthetic dysfunction. Patients with either manifestation of SARS-CoV-2 infection and E-ALT experienced more severe disease.

Keywords: COVID-19 ALI in children; acute liver failure; acute liver injury and MISC; elevated ALT; liver involvement in SARS-CoV2.

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Conflict of interest statement

The authors declare no conflict of interest related to this study.

Figures

FIGURE 1
FIGURE 1
Flow‐chart of study cohort demonstrating the differences of ALI in the COVID‐19 and MIS‐C cohorts; A total of 291 patients were included in the study: 220 (76%) and 71 (24%) were diagnosed with COVID‐19 and MIS‐C, respectively. ALI was detected in 31% (n = 69) of children with COVID‐19 and 51% (n = 36) of children with MIS‐C. Severe injury defined as ALT > 200 U/L was noted in 8% of children with COVID‐19 and 4% of children with MIS‐C, respectively. Abbreviations: ALI, acute liver injury; ALT, alanine aminotransferase; COVID‐19, Coronavirus disease 2019; MIS‐C, system inflammatory syndrome in children
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References

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