Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct 27;14(10):1907-1919.
doi: 10.4254/wjh.v14.i10.1907.

Hepatic involvement in children with acute bronchiolitis

Hasan M Isa  1   2 , Asma Z Hasan  3 , Sara I Khalifa  1 , Sana S Alhewaizem  4 , Abdulrahman D Mahroofi  5 , Fatema N Alkhan  1 , Mohammed Al-Beltagi  6   7   8
Affiliations

Hepatic involvement in children with acute bronchiolitis

Hasan M Isa et al. World J Hepatol. .

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.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflict of interest for this article.

Figures

Figure 1
Figure 1
The study flow chart describes hospitalized infants with acute bronchiolitis.
Figure 2
Figure 2
Clinical characteristics of 166 infants admitted with the diagnosis of acute bronchiolitis.
Figure 3
Figure 3
Comparison of liver function tests in infants admitted with acute bronchiolitis at admission and during follow-up. ALP: Alkaline phosphatase; ALT: Alanine aminotransferase; GGT: Gamma-glutamyl transferase.
See this image and copyright information in PMC

References

    1. Giordano S, Di Gangi M, Failla MC, Bruno L, Falcone V, Dones P. Respiratory syncytial virus bronchiolitis and hypertransaminasemia. Infez Med . 2018;26:81–84. - PubMed
    1. Piedimonte G, Perez MK. Respiratory syncytial virus infection and bronchiolitis. Pediatr Rev . 2014;35:519–530. - PMC - PubMed
    1. Al-Maskari N, Mohsin J, Al-Maani A, Al-Macki N, Al-Ismaili S. Atypical Presentations of Respiratory Syncytial Virus Infection: Case Series. Sultan Qaboos Univ Med J . 2016;16:e86–e91. - PMC - PubMed
    1. Hall CB, Weinberg GA, Iwane MK, Blumkin AK, Edwards KM, Staat MA, Auinger P, Griffin MR, Poehling KA, Erdman D, Grijalva CG, Zhu Y, Szilagyi P. The burden of respiratory syncytial virus infection in young children. N Engl J Med . 2009;360:588–598. - PMC - PubMed
    1. Thorburn K, Fulton C, King C, Ramaneswaran D, Alammar A, McNamara PS. Transaminase levels reflect disease severity in children ventilated for respiratory syncytial virus (RSV) bronchiolitis. Sci Rep . 2018;8:1803. - PMC - PubMed